A Study of Floppy Eyelid Syndrome and Its Ophthalmic and Systemic Associations.

Abstract

Introduction: Floppy eyelid syndrome (FES) is characterized by very elastic upper lids that became easily distorted and evertible with minimal lateral traction and chronic papillary conjunctivitis of the upper palpebral conjunctiva. Apart from various ocular associations, FES has been associated with various systemic diseases like obesity, hypertension, IHD and DM. The present study was thus planned to gather data regarding the prevalence of FES and its ocular and systemic associations in the local population. Materials & Methods: A prospective non-randomized cross-sectional observational study was conducted at a tertiary care center including a total of 1600 cases. All cases were screened for floppy eye lid syndrome. Detailed history, ocular and systemic examination was conducted in all FES positive patients including screening for OSA. Results: Eighty one patients (5.06%) out of 1600 screened were diagnosed to have FES. Prevalence of FES was more in males (71.6%) as compared to females (23.6%). Of the 81 patients detected to have FES, 57 were in the age group of 40-60 years. The commonest ocular involvement was superficial punctate keratopathy seen in 43.2% followed by tear film abnormalities seen in 37%. The most common systemic association as determined by Berlin questionnaire was OSA (74.1%). Conclusion: Prevalence of FES in our study was 5.1%. The commonest ocular association was superficial punctate keratopathy. Commonest systemic association was obstructive sleep apnoea. We thus recommend that screening for OSA should be undertaken in all patients of FES.

Prevalence of Obstructive Sleep Apnea With Floppy Eyelid Syndrome: A Systematic Review and Meta-analysis

“…Of the included patients, 368 were male (77.6%) and the average age was 55.10 years. The current study included 4 prospective non-randomized cross-sectional observational studies, 24-27 7 retrospective analyses, 8,28-33 and 1 case-control study. 5 The overall prevalence of OSA in FES was 57.1% (95% CI: 46.5–74.8%), shown in Figure 4.…”

“…FES as an outcome of OSA was initially suggested by Culbertson and Tseng in 1994 6 when describing hypoxic tissue in OSA patients, and corroborated by McNab when the treatment of OSA in a 32-year-old male reversed FES. Since then, 1 case-control study by Ezra et al 5 has demonstrated a significant association of FES with OSA, but other retrospective 8,[27][28][29][30][31][32][33] and prospective studies [24][25][26] have also observed this link. The strongest hypothesis bridging these conditions relates to the chronic, transient, hypoxic, and reperfusion insults posed on the vasculature as a result of frequent apnea while a person with OSA is asleep.…”

“…The diagnostic criteria for FES among most included studies were based on upper eyelid eversion, tarsal laxity, and diffuse papillary conjunctival changes. 4,11,[24][25][26]28,30,33 Sward et al 27 used the terms "lax eyelid syndrome" (LES) and FES interchangeably and graded degree of eyelid laxity according to millimeters of eyelid separation from a laxometer. Fowler et al 8 retrospectively reviewed patients with a clinical diagnosis of FES, but did not mention the diagnostic criteria used.…”

“…While this study collates considerable knowledge about the relationship between FES and OSA, several limitations must be acknowledged. First, we observed considerable selection bias as most studies did not attempt to randomize patient selection and reportedly screened patient records [24][25][26][27] for eligibility. Furthermore, the majority study designs were cohort studies, so a lack of control groups prevented odds ratios and tests of significance from being undertaken.…”