Eyelid Syndrome

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


ALERT


• Strong association of OSAHS and systemic sequelae.


– Cardiovascular disease


– Stroke


– Obesity


– Metabolic syndrome


– Cognitive and emotional disorders


– Drowsiness-related accidents

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Nov 9, 2016 | Posted by in OPHTHALMOLOGY | Comments Off on Eyelid Syndrome

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