BASICS

DESCRIPTION

A loose and unstable upper eyelid associated with a chronic papillary conjunctivitis and spontaneous eversion of the eyelid during sleep (1)[C]

EPIDEMIOLOGY

Incidence

• Males > female

• Obesity (2)[C]

• Unilateral or bilateral

RISK FACTORS

• Obstructive sleep apnea—hypopnea syndrome (OSAHS)

• Recurrent mechanical rubbing

GENERAL PREVENTION

CPAP for treatment of sleep apnea may improve floppy eyelid.

PATHOPHYSIOLOGY

Upregulation of elastin-degrading enzymes (matrix metalloproteinases) secondary to reperfusion ischemia and repeated mechanical trauma on sleeping side or by repeated rubbing.

ETIOLOGY

• Unknown

• Elongation of tarsal plate allows flaccidity of upper eyelid

• Ischemia secondary to obstructive sleep apnea – hypopnea syndrome leads to optic neuropathy, papilledema, glaucoma (3)[C], (4)[C]

COMMONLY ASSOCIATED CONDITIONS

• Obstructive sleep apnea—hypopnea syndrome (OSAHS), >90%

• High body mass index

• Keratoconus on sleeping side

DIAGNOSIS

HISTORY

• Chronic mucous secretion

• Foreign body sensation—worse upon awakening

• Eversion of upper eyelid during sleep

• Sleeps on affected side of face

• Snoring

• Smoking

PHYSICAL EXAM

• Downward pointing upper eyelashes—lash ptosis

• Easily everted upper eyelid

• Soft and rubbery consistency of upper eyelid tarsal plate

• Horizontal laxity upper and possibly lower eyelids

• Chronic papillary conjunctivitis of upper eyelid

• Ptosis

• Lagophthalmos with secondary corneal punctuate keratitis

DIAGNOSTIC TESTS & INTERPRETATION

Lab

Initial lab tests

Sleep study.

Follow-up & special considerations

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