Floppy Eyelid Syndrome: Stretching the Limits

Ezra, Daniel G.; Beaconsfield, Michele; Collin, Richard

doi:10.1016/j.survophthal.2009.02.025

Cited by 48 publications

(44 citation statements)

References 88 publications

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“…The initial description [1] of the floppy eye syndrome concerned 11 obese patients, but the studies that followed reported varied associations [2, 3, 5, 6]. The results of the current study did not confirm that obese patients present the syndrome more often.…”

Section: Discussioncontrasting

confidence: 81%

“…In the literature, there is a discrepancy regarding lid laxity, especially the lack of a common consensus for laxity classification in FES [11]. Several authors attempted to define hyperlaxity either by the length of vertical distance between the palpebral rim and the pupil [11], horizontal distraction, snapback, vertical lid pull, horizontal distraction of the lid to the globe, proportion of the tarsal plate everted, by measuring the effort made to evert the lid and other [2]. …”

Section: Discussionmentioning

confidence: 99%

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The Floppy Eyelid Syndrome: Evaluating Lid Laxity and Its Correlation to Sleep Apnea Syndrome and Body Mass Index

et al. 2012

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Background. The aim of this study is to present a method of lid laxity evaluation and investigate whether there is an association between floppy eyelid syndrome (FES) and body mass index (BMI) in sleep apnea syndrome (SAS) patients compared to normal subjects. Method. A total of 135 participants (81 patients with SAS and 54 normal subjects) had a full ophthalmologic examination. The presence of FES was estimated in relation to SAS and BMI. Results. The floppy eyelid was characterized “hyperelastic,” “FES stage 1 (asymptomatic),” or “FES stage 2 (symptomatic)” depending on its laxity capacity. Hyperelastic floppy eyelid in SAS patients was statistically significant (P < 0.05) when compared to normals. Similarly, the presence of hyperelasticity in high-BMI SAS patients was also statistically significant (P < 0.05) when compared to low-BMI SAS patients. Floppy eyelid syndrome was more frequent in SAS patients than in normal subjects (P < 0.05), but no association was found between FES and obesity (P > 0.05). Conclusion. A classification of FES is proposed based on lid laxity. In addition to this, our data suggests a clear association of hyperelasticity and FES to SAS patients but no association between obesity and FES.

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Section: Discussioncontrasting

confidence: 81%

Section: Discussionmentioning

confidence: 99%

The Floppy Eyelid Syndrome: Evaluating Lid Laxity and Its Correlation to Sleep Apnea Syndrome and Body Mass Index

et al. 2012

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“…Urrets-Zavalia syndrome, an uncommon postoperative complication of PKP, has also been associated with keratoconus, which suggests an intrinsic abnormality in irises with this disease (10) . Others have described an association between keratoconus and floppy eyelids (11,12) . Thus, multiple lines of evidence indicate extracorneal manifestations of keratoconus involving the iris and/or the periocular skin and connective tissues.…”

Section: Introductionmentioning

confidence: 99%

Quantitative analysis of iris parameters in keratoconus patients using optical coherence tomography

Bonfadini¹,

Arora²,

Vianna³

et al. 2015

Arquivos Brasileiros De Oftalmologia

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Purpose: To investigate the relationship between quantitative iris parameters and the presence of keratoconus. Methods: Cross-sectional observational study that included 15 affected eyes of 15 patients with keratoconus and 26 eyes of 26 normal age-and sex-matched controls. Iris parameters (area, thickness, and pupil diameter) of affected and unaffected eyes were measured under standardized light and dark conditions using anterior segment optical coherence tomography (AS-OCT). To identify optimal iris thickness cutoff points to maximize the sensitivity and specificity when discriminating keratoconus eyes from normal eyes, the analysis included the use of receiver operating characteristic (ROC) curves. Results: Iris thickness and area were lower in keratoconus eyes than in normal eyes. The mean thickness at the pupillary margin under both light and dark conditions was found to be the best parameter for discriminating normal patients from keratoconus patients. Diagnostic performance was assessed by the area under the ROC curve (AROC), which had a value of 0.8256 with 80.0% sensitivity and 84.6% specificity, using a cutoff of 0.4125 mm. The sensitivity increased to 86.7% when a cutoff of 0.4700 mm was used. Conclusions: In our sample, iris thickness was lower in keratoconus eyes than in normal eyes. These results suggest that tomographic parameters may provide novel adjunct approaches for keratoconus screening.

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“…The suggested treatments for FES have continued to evolve. Conservative measures, including topical ocular lubrication, mild topical steroids, nocturnal eyelid taping and eye shield application, have been used with varying degrees of success . However, the impracticality and discomfort of these have resulted in a wide range of surgical techniques that aim to tighten and stabilize the upper eyelid.…”

Section: Introductionmentioning

confidence: 99%

Floppy eyelid syndrome “plasty” procedure: Employment of a periosteal transposition flap for surgery of floppy eyelid syndrome

Waldie

Francis

Coroneo

et al. 2019

Clinical Exper Ophthalmology

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Importance Floppy eyelid syndrome “plasty” (FESplasty) is a surgical technique that addresses underlying superior tarsal plate and lateral canthal instability in floppy eyelid syndrome (FES) and aims to restore normal anatomical and physiological function to the upper eyelid. Background To describe the use of FESplasty in the surgical management of FES, and to report outcomes in an initial patient cohort. Design Retrospective study. Participants Seven patients (nine eyelids) with FES undergoing FESplasty. Methods A single surgeon (G.W.) performed all procedures. FESplasty utilizes a periosteal flap based at the inferolateral orbital rim, and applied to the anterior surface of the upper tarsal plate. It is combined with a titrated shortening procedure of the upper eyelid. Patient demographics, comorbidities and ocular symptoms and signs were recorded preoperatively. Pre‐ and postoperative upper eyelid distractibility were graded and documented. Main Outcome Measures Postoperative improvement in upper eyelid distractibility and symptomatology, operative complications and FES recurrence. Results FES symptoms and upper eyelid laxity improved at last follow‐up (average 24 weeks) in all patients, with no FES recurrences after a maximum follow‐up of 36 weeks. One patient, in whom FESplasty exacerbated his pre‐existing aponeurotic ptosis, required definitive ptosis surgery subsequently. There was one case of postoperative wound infection. Obstructive sleep apnoea was present in four of the seven patients. The remaining three patients were awaiting assessment. Conclusions and Relevance FESplasty is likely to confer long‐term effective stabilization of the lateral canthal tendon, lateral commissure and superior tarsal plate. Anatomical and functional results appeared to have been successfully achieved.

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Floppy Eyelid Syndrome: Stretching the Limits

Cited by 48 publications

References 88 publications

The Floppy Eyelid Syndrome: Evaluating Lid Laxity and Its Correlation to Sleep Apnea Syndrome and Body Mass Index

The Floppy Eyelid Syndrome: Evaluating Lid Laxity and Its Correlation to Sleep Apnea Syndrome and Body Mass Index

Quantitative analysis of iris parameters in keratoconus patients using optical coherence tomography

Floppy eyelid syndrome “plasty” procedure: Employment of a periosteal transposition flap for surgery of floppy eyelid syndrome

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