The Overlooked Floppy Eyelid Syndrome: From Diagnosis to Medical and Surgical Management
Abstract
:1. Introduction
2. Materials and Methods
3. Pathophysiology
3.1. Mechanical Trauma
3.2. Oxidative Damage from Hypoxia and Reperfusion
3.3. Association with Systemic Conditions
3.4. Genetic Factors
3.5. Histological Characteristics
4. Clinical Presentation
5. Comorbidities
5.1. Obstructive Sleep Apnea
5.2. Keratoconus
5.3. Glaucoma
6. Diagnosis
7. Conservative Management
7.1. Ocular Surface Lubrication
7.2. Eyelid Taping
7.3. Meibomian Gland Dysfunction
7.4. Topical Anti-Inflammatory Therapy
7.5. Continuous Positive Airway Pressure (CPAP)
7.6. Oculoplastic Evaluation
8. Surgical Treatment
8.1. Lateral Tarsal Strip Procedure
8.2. Medial Canthoplasty
8.3. Full-Thickness Wedge Resection
8.4. Upper Eyelid Blepharoplasty
8.5. Canthal Suspension Procedures
9. Conclusions
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Conflicts of Interest
References
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Aspect | Diagnostic Approach | Therapeutic Approach |
---|---|---|
Eyelid Function | Assessment of the ease of upper eyelid eversion and observation of any spontaneous eversion during examination. FES patients typically exhibit significant laxity [3,6,51,77]. | Nighttime use of preservative-free ointments or gels for better protection. Eyelid taping combined with the application of ointment during sleep to prevent exposure. Early referral to an oculoplastic specialist for further evaluation [78,79,80]. |
Chronic Inflammation | Evaluation for signs such as papillary conjunctivitis, conjunctival hyperemia, and corneal epithelial changes [2]. | Maintaining ocular surface lubrication with preservative-free products. Use of short courses of mild corticosteroids like loteprednol or fluorometholone for acute inflammation. Avoidance of non-steroidal anti-inflammatory eyedrops for risk of corneal melting [81,82,83,84]. |
Snap-back Test | Gentle pulling of the eyelid away from the globe and observing its return speed and extent. In FES, the eyelid returns slowly and may not fully revert [85,86]. | Similar to eyelid function management. Addressing underlying systemic conditions like Obstructive Sleep Apnea (OSA). Continuous Positive Airway Pressure (CPAP) therapy to improve chronic inflammation and ocular symptoms [42]. |
Fluorescein Staining | Visualization of corneal epithelial defects caused by chronic exposure due to eyelid laxity, aiding in quantifying ocular surface compromise [87,88]. | Use of preservative-free lubricating drops, gels, or ointments to protect the cornea. Avoiding non-steroidal anti-inflammatory eyedrops to prevent corneal melting [83,84]. |
Schirmer Test | Measurement of tear production using filter paper strips placed inside the lower eyelid to identify aqueous tear deficiency [89]. | Enhancing tear film volume and stability with preservative-free lubricants and managing chronic inflammation [90]. |
Tear Break-up Time (TBUT) | Measurement of the interval between a blink and the appearance of dry spots on the cornea, indicating tear film instability [91]. | Manage low tear film and, importantly, meibomian gland dysfunction and blepharitis, to improve tear film quality. Additionally, oral low-dose tetracycline for severe cases to reduce lid inflammation [89,92,93,94,95]. |
Meibomian Gland Examination | Evaluation of meibomian gland dysfunction (MGD) through techniques like meibography or gland function assessment [89,92]. | Consistent daily application of heat, eyelid hygiene, and antibiotic ointments to manage blepharitis. Oral low-dose tetracycline in severe cases. Addressing systemic conditions like OSA to reduce ocular symptoms. Early referral to a specialist if necessary [93,94,95]. |
Grade | Description |
---|---|
0 | No floppy eyelid; no visible tarsal conjunctiva. |
1 | Mild severity; less than one-third of the upper tarsal conjunctiva is visible. |
2 | Moderate severity; between one-third and one-half of the upper tarsal conjunctiva is visible. |
3 | Severe cases; more than half of the tarsal conjunctiva is visible. |
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Scarabosio, A.; Surico, P.L.; Patanè, L.; Tambasco, D.; Kahale, F.; Zeppieri, M.; Parodi, P.C.; Coassin, M.; Di Zazzo, A. The Overlooked Floppy Eyelid Syndrome: From Diagnosis to Medical and Surgical Management. Diagnostics 2024, 14, 1828. https://doi.org/10.3390/diagnostics14161828
Scarabosio A, Surico PL, Patanè L, Tambasco D, Kahale F, Zeppieri M, Parodi PC, Coassin M, Di Zazzo A. The Overlooked Floppy Eyelid Syndrome: From Diagnosis to Medical and Surgical Management. Diagnostics. 2024; 14(16):1828. https://doi.org/10.3390/diagnostics14161828
Chicago/Turabian StyleScarabosio, Anna, Pier Luigi Surico, Luca Patanè, Damiano Tambasco, Francesca Kahale, Marco Zeppieri, Pier Camillo Parodi, Marco Coassin, and Antonio Di Zazzo. 2024. "The Overlooked Floppy Eyelid Syndrome: From Diagnosis to Medical and Surgical Management" Diagnostics 14, no. 16: 1828. https://doi.org/10.3390/diagnostics14161828