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

Abstract

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.

Effect of Sleep Position on the Development of Ectropion or Entropion in Aged Population

“…Beis has proposed that FES is an extreme situation of lid laxity. Our results could potentially broaden the already known relationship regarding sleep position and FES [15]. The difference we have found in the correlation between the preferred sleep side and the morbidity between the two groups may stems from the fact that hypoxia is more dominant in the pathophysiology of ectropion than entropion.…”

“…The primary pathology of both involutional ectropion and FES is lid laxity [15]. Figueira et al also found that healthy patients without eyelid pathology demonstrate a correlation between the side on which they historically or customarily sleep and the laxity of the ipsilateral upper eyelid [19].…”

“…Until now, sleeping position, notably of the head, has not been identified as a risk factor for entropion or ectropion. Since the laxity of the eyelid is the pathophysiological basis for ectropion and entropion, a correlation between those conditions and their development seems logical [15]. The hypothesis of the study is that prolonged sleeping on one side increases the risk for the development of involutional ectropion or entropion.…”

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

“…CD asymmetry ie >or = 0.2 difference between two eyes 4. IOP asymmetry ie > or = 3mmHg difference with IOP > or = 16 These suspects were further evaluated by complete glaucoma workup Blood sugar levels:-random, fasting and post prandial levels were done.…”

Relation of Floppy Eyelid Syndrome with Obstructive Sleep Apnea

“…The patient was diagnosed with severe obstructive sleep apnea syndrome (OSAS) and his symptoms improved with automatic continuous positive airway pressure (CPAP) treatment at 9 cmH2O pressure. Floppy eyelid syndrome is a clinical entity which has already been extensively investigated in terms of clinical characteristics, local and systemic associations, and treatment since its first description (1). Recent studies have suggested a relationship between OSAS and FES (2).…”