Lax eyelid syndrome (LES), obstructive sleep apnea (OSA), and ocular surface inflammation

Sward, Mackenzie; Kirk, Clayton; Kumar, Sunita; Nasir, Nabila; Adams, William; Bouchard, Charles S.

doi:10.1016/j.jtos.2018.04.003

Cited by 31 publications

(16 citation statements)

References 31 publications

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“…Eyelid hyperlaxity has a well-known association with obstructive sleep apnea (OSA), which occurs in up to 33% men and 17% women, making this a common but overlooked condition [40]. Finally, matrix metalloproteinase-9 has also been detected in the tear film of patients with (LES) and OSA [41], supporting an inflammatory component of LES. FES microbiome studies have also not been reported.…”

Section: Introductionmentioning

confidence: 99%

Assessing the ocular surface microbiome in severe ocular surface diseases

et al. 2020

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Purpose: There is growing evidence for a critical role of the microbiome in ocular health and disease. We performed a prospective, observational study to characterize the ocular surface microbiome (OSM) in four chronic ocular surface diseases (OSDs) and healthy controls.Methods: Sterile swabs were used to collect samples from each eye of 39 patients (78 eyes). Sterile technique and multiple controls were used to assess contamination during DNA extraction, amplification and sequencing. Concurrent use of topical antibiotics, steroids, and bandage contact lenses (BCLs) was documented.Results: Despite the low biomass of the ocular surface, 47/78 (60%) eyes sampled had positive sequencing reads. We observed that half of patients (8/17, 47%) had distinct microbiomes in each eye. Healthy controls had a Lactobacillus/Streptococcus mixture or significant Corynebacterium. Staphylococcus predominated in 4/7 (57%) patients with Stevens-Johnson Syndrome (SJS) in at least one eye, compared to 0/10 healthy controls. Interestingly, 8/11 (73%) eyes with SJS were using BCLs, including 4/5 (80%) eyes dominated by Staphylococcus. Lax eyelid syndrome (LES) and Dry Eye Disease (DED) patients had similar OSMs, with Corynebacterium being the most prevalent bacteria. Alpha diversity was higher in controls and ocular graft-vs-host (oGVHD) patients compared to the other OSDs.Conclusions: Only 50% of the 39 patients had similar microbiomes in each eye. A majority of healthy eyes had a Lactobacillus/Streptococcus mix or Corynebacterium microbiome. Staphylococcus predominated in SJS, Lactobacillus in oGVHD, and Corynebacterium in DED and LES. There may be an association between different OSDs and the microbiome.

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Section: Introductionmentioning

confidence: 99%

Assessing the ocular surface microbiome in severe ocular surface diseases

et al. 2020

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“…Globally, 11 articles were included in the qualitative and quantitative analysis (Fig. 1), whose general features are reported in supplementary materials [19,20,[23][24][25][26][27][28][29][30][31]. Specifically, 9/11 [19,20,23,24,[26][27][28][29]31] and 7/11 [19, 23, 25-27, 29, 30] studies reported information regarding the prevalence of LEC and FES among OSA-affected patients respectively.…”

Section: Electronic Database Search Resultsmentioning

confidence: 99%

Lax eyelid condition (LEC) and floppy eyelid syndrome (FES) prevalence in obstructive sleep apnea syndrome (OSA) patients: a systematic review and meta-analysis

Aiello

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Alessandri‐Bonetti

et al. 2022

Graefes Arch Clin Exp Ophthalmol

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Purpose Lax eyelid condition (LEC) and floppy eyelid syndrome (FES) represent two distinct conditions which have been associated with several ocular and systemic comorbidities. The main aim of this systematic review and meta-analysis is to explore the available literature to estimate the prevalence rate of LEC and FES in obstructive sleep apnea (OSA). Methods The protocol of this systematic review and meta-analysis has been registered in PROSPERO. Four electronic databases (PubMed/MEDLINE, Google Scholar, Cochrane Library, Web of Science) were searched from inception to December 24, 2021. A random intercept logistic regression model was carried out for the analysis of overall proportions. Odds ratio and mean difference were reported as measures of the effect size in the presence of binary and continuous outcomes, respectively. The estimated numbers of LEC/FES patients in OSA were calculated by multiplying the prevalence rate determined by our random-effects model and the corresponding Benjafield et al.’s population prospect. Results We included 11 studies comprising 1225 OSA patients of whom 431 and 153 affected by LEC and FES, respectively. Our model estimated a pooled prevalence rate for LEC and FES in OSA patients of 40.2% (95%CI: 28.6–53.1%) and of 22.4% (95%CI: 13.8–34.2%), respectively. The number of LEC/FES affected individuals among OSA patients is expected to peak up to 376 and to 210 million, respectively. OSA patients appeared to have a 3.4 (95%CI: 2.2–5.2) and a 3.0 (95%CI: 1.7–5.5) increased risk of developing LEC and FES than the healthy counterpart. Conclusion Prevalence of LEC and FES is higher in OSA-affected patients compared to controls. More studies are warranted to investigate the mechanisms leading to the development of LEC and/or FES in OSA patients, as well as the feasibility of the adoption of these clinical findings as screening tools for OSA.

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“…Similarly, the 'snapback' test 6,36 is a diagnostic procedure run to evaluate the eyelid tone and the horizontal laxity severity. This is usually only done for the lower lid.…”

Section: Measurement Testsmentioning

confidence: 99%

“…To overcome this limitation, Karger et al 16 and Sward 36 introduced two devices ('strain gauge device' and 'laxometer') that are able to objectively measure the applied force required for the vertical displacement of the upper eyelid.…”

Section: Measurement Testsmentioning

confidence: 99%

Floppy eyelid, an under-diagnosed syndrome: a review of demographics, pathogenesis, and treatment

et al. 2021

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Floppy eyelid syndrome (FES) is a frequent eyelid disorder characterized by eyelid laxity that determines a spontaneous eyelid eversion during sleep associated with chronic papillary conjunctivitis and systemic diseases. FES is an under-diagnosed syndrome for the inaccuracy of definition and the lack of diagnostic criteria. Eyelid laxity can result from a number of involutional, local, and systemic diseases. Thus, it is pivotal to use the right terminology. When the increased distractibility of the upper or lower eyelid is an isolated condition, it is defined as ‘lax eyelid condition’ (LAC). When laxity is associated with ocular surface disorder such as papillary conjunctivitis and dry eyes, it can be referred to as ‘lax eyelid syndrome’ (LES). However, FES is characterized by the finding of a very loose upper eyelid which everts very easily and papillary tarsal conjunctivitis affecting a specific population of patients, typically male, of middle age and overweight. Obesity in middle-aged male is also recognized as the strongest risk factor in obstructive sleep apnea-hypopnea syndrome, (OSAHS). FES has been reported as the most frequent ocular disorder associated with OSAHS. Patients with FES often complain of non-pathognomonic ocular signs and symptoms such as pain, foreign body sensation, redness, photophobia, and lacrimation. Due to these clinical features, FES is often misdiagnosed while an early recognition might be important to avoid its chronic, distressing course and the associated morbidities. This review provides an updated overview on FES by describing the epidemiology, proposed pathogenesis, clinical manifestations, related ocular, and systemic diseases, and treatment options.

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Lax eyelid syndrome (LES), obstructive sleep apnea (OSA), and ocular surface inflammation

Cited by 31 publications

References 31 publications

Assessing the ocular surface microbiome in severe ocular surface diseases

Assessing the ocular surface microbiome in severe ocular surface diseases

Lax eyelid condition (LEC) and floppy eyelid syndrome (FES) prevalence in obstructive sleep apnea syndrome (OSA) patients: a systematic review and meta-analysis

Floppy eyelid, an under-diagnosed syndrome: a review of demographics, pathogenesis, and treatment

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