BSOPRS: Belgian Society of Ophthalmic Plastic and Reconstructive Surgery

The floppy eyelid syndrome (FES) is a relatively rare ophthalmic disease, which consists of hyperlaxity of the eyelids. Usually in obese, middle-aged men. Sometimes though it can occur in women and persons of normal weight, even in children. A large number of these patients suffer likewise of obstructive sleep apnea (OSA) (partial collapse of the pharynx during breathing, resulting in loud snoring and gasping).   

Patients complains are mostly due to chronic red, irritated watery eyes, itching and sticky secretions in the corner of the eye, especially on waking. The symptoms can occur bilaterally or just in one eye. General complaints: chronic fatigue and headaches upon waking.   

The ophthalmic examination shows: a papillary conjunctivitis with mild bulbar hyperemia, often on the side where the patient sleeps. Punctiform keratitis, mucosal filaments in the tear film, a pseudo-ptosis and a "rubbery" consistency of the eyelids. The upper eyelids can be flipped over by minimal manipulation. The disease is often associated with blepharitis on rosacea and Meibomius gland dysfunction (MGD)

The treatment of the floppy eyelid syndrome:

- moistening the eyes with artificial tears and a "moister chamber". 

- In severe cases,  surgery is performed: a horizontal shortening of the four eyelids by full-thickness resection of one third of the lids.  

As important as treating the eyes is addressing the obesity and obstructive sleep apnea. 

Clinical Pearl:  interrogation of the partner of the patient gives a much more realistic picture about the degree of heavy snoring and sleep apnea.