Floppy Eyelid Syndrome

For several days, the left eye and eyelids of a 60-year-old obese man had been red and irritated. The symptoms were worse in the morning after waking. The patient had recently started wearing a nighttime continuous positive airway pressure mask for obstructive sleep apnea (OSA). He slept exclusively on his left side.

Leonid Skorin, Jr, DO, of Albert Lea, Minn, observed that the left upper eyelid was loose and was easily everted with minimal digital manipulation. The eyelid also felt rubbery and soft. The underlying palpebral conjunctiva was edematous, hyperemic, and inflamed. Corneal evaluation with a slit lamp revealed punctate keratopathy.

This patient has floppy eyelid syndrome. The condition is usually found in obese middle-aged men who have OSA. These patients frequently sleep on their side to alleviate the symptoms of OSA. While the patient is sleeping on the side, the face presses into the pillow and the upper eyelid everts, causing mechanical inflammation and irritation to the conjunctival surface.

Conservative treatment involves ocular lubrication (with preservative-free artificial tears) during the day, avoidance of sleeping exclusively on one side, and the use of a plastic or metallic eye shield while sleeping. If conservative measures fail, consider surgery to tighten the lax eyelid. The OSA must also be addressed.

This patient was treated conservatively. Two weeks later, his ocular symptoms had significantly abated. He is being monitored for recurrence.