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Floppy eyelid syndrome

Pham, Thu T; Perry, Julian D

Current Opinion in Ophthalmology: September 2007 - Volume 18 - Issue 5 - p 430–433
doi: 10.1097/ICU.0b013e3282ced08e
Oculoplastic and orbital surgery

Purpose of review Although floppy eyelid syndrome causes significant ocular symptoms and morbidity, the condition is often underdiagnosed. This review will highlight diagnostic features of the condition, emphasizing recent advances in the understanding of its pathophysiology. Current therapeutic strategies and surgical techniques are discussed.

Recent findings Current concepts regarding the underlying pathophysiology of floppy eyelid syndrome revolve around upregulation of elastin degrading enzymes and mechanical factors. Together, these forces cause instability of the eyelid scaffold, resulting in eyelid malposition and ocular symptoms. Newer surgical treatments aim to preserve tarsus to improve eyelid stability and position.

Summary Floppy eyelid syndrome – an underdiagnosed condition – produces significant ocular morbidity. Symptoms range from occasional redness and irritation to corneal ulcer. Diagnosis is based on ocular signs, including easy or spontaneous eversion of the upper eyelids in conjunction with conjunctivitis and keratitis. The condition, associated with body mass index and obstructive sleep apnea, should be suspected in any obese patient with a chronic red and tearing eye. Treatment consists of supportive measures such as ocular lubrication, eyelid taping or a shield, and surgery to address horizontal laxity and redundant eyelid tissues.

Cole Eye Institute, Cleveland Clinic, Cleveland, Ohio, USA

Correspondence to Julian D. Perry, MD, 9500 Euclid Ave i-13, Cleveland, OH 44195, USA Tel: +1 216 444 3635; fax: +1 216 445-3676; e-mail:

© 2007 Lippincott Williams & Wilkins, Inc.