Floppy Eyelid Syndrome: pathogenesis, diagnosis, treatment
DOI: 10.32364/2311-7729-2025-25-1-7
T.N. Yurieva1–3, D.Yu. Samsonov1, A.Yu. Buglanov4
1Irkutsk Branch of the S. Fyodorov Eye Microsurgery Federal State Institution, Irkutsk, Russian Federation
2Irkutsk State Medical Academy of Professional Education — Branch of the Russian Medical Academy of Continuous Professional Education, Irkutsk, Russian Federation
3Irkutsk State Medical University, Irkutsk, Russian Federation
4Irkutsk Regional Clinical Hospital, Irkutsk, Russian Federation
Floppy hyperextensible eyelid syndrome is a disease characterized by spontaneous eyelid flipping during sleep and giant papillary conjunctivitis. The articles show "floppy eyelid syndrome" can be translated as "atonic eyelid syndrome", "flapping eyelid syndrome", "flabby eyelid syndrome" or "hyperelastic eyelid syndrome". It is believed that that "hyperextensible eyelid syndrome" is the most precise term reflecting the disease essence. Abnormal floppy eyelids may be caused by a number of involutional local and systemic diseases. A significant distance between the upper/lower eyelid and the eyeball may be an isolated condition or an event associated with abnormal quantitative and qualitative characteristics of the tear film. Floppy eyelid syndrome can also occur in a fairly specific group of patients (typically, in middle-aged overweight males). Very loose and easily flipping upper eyelids associated with papillary conjunctivitis are typically detected in the population.
Floppy eyelid syndrome is reported to be the most common eye disease associated with obstructive sleep apnea/hypopnea, and obesity is the strongest risk factor for the sleep abnormality in middle-aged men. Often patients with sleep apnea report concomitant ocular signs and symptoms such as pain, foreign body sensation, redness, photophobia, lacrimation, and purulent discharge. Due to the lack of clear diagnostic criteria and a blurred clinical presentation, patients just treat the syndrome complications (e. g., conjunctivitis, keratitis) in vain for a long time regardless of etiology and pathogenesis of the disease.
Aim: to provide a literature review on probable pathogenesis and clinical manifestations of the floppy eyelid syndrome including a case history.
Keywords: conjunctivitis, corneal diseases, ectropion, eyelid laxity, floppy eyelid syndrome, obstructive sleep apnea/hypopnea.
For citation: Yurieva T.N., Samsonov D.Yu., Buglanov A.Yu. Floppy Eyelid Syndrome: pathogenesis, diagnosis, treatment. Russian Journal of Clinical Ophthalmology. 2025;25(1):49–53 (in Russ.). DOI: 10.32364/2311-7729-2025-25-1-7
About the authors:
Tatiyana N. Yurieva — Dr. Sc. (Med.), Professor, Deputy Director for Science of the Irkutsk Branch of the S. Fyodorov Eye Microsurgery Federal State Institution; 337, Lermontov str., Irkutsk, 664033, Russian Federation; Professor of the Department of Ophthalmology, Irkutsk State Medical Academy of Professional Education — Branch of the Russian Medical Academy of Continuous Professional Education; 100, Yubileinyy subdistrict, Irkutsk, 664049, Russian Federation; Professor of the Department of Eye Diseases, Irkutsk State Medical University; 1, Krasnogo Vosstaniya str., Irkutsk, 664003, Russian Federation; ORCID iD 0000-0003-0547-7521
Dmitry Yu. Samsonov — C. Sc. (Med.), Ophthalmologist, Head of the Scientific and Educational Department, Irkutsk Branch of the S. Fyodorov Eye Microsurgery Federal State Institution; 337, Lermontov str., Irkutsk, 664033, Russian Federation; ORCID iD 0000-0001-7971-4521
Andrey Yu. Buglanov — Ophthalmologist, Irkutsk Regional Clinical Hospital; 100, Yubileinyy subdistrict, Irkutsk, 664049, Russian Federation.
Contact information: Tatiyana N. Yurieva, e-mail: nauka@mntk.irkutsk.ru
Financial Disclosure: no authors have a financial or property interest in any material or method mentioned.
There is no conflict of interest.
Received 27.02.2024.
Revised 25.03.2024.
Accepted 17.04.2024.
2. Brown M.D., Potter J.W. Floppy eyelid syndrome: a case report and clinical review. J Am Optom Assoc. 1992;63(5):309–314. PMID: 1593066
3. Culbertson W.W., Ostler H.B. The floppy eyelid syndrome. Am J Ophthalmol. 1981;92(4):568–575. DOI: 10.1016/0002-9394(81)90652-8
4. Van den Bosch W.A., Lemij H.G. The lax eyelid syndrome. Br J Ophthalmol. 1994;78(9):666–670. DOI: 10.1136/bjo.78.9.666
5. Ansari Z., Singh R., Alabiad C., Galor A. Prevalence, risk factors, and morbidity of eye lid laxity in a veteran population. Cornea. 2015;34(1):32–36. DOI: 10.1097/ICO.0000000000000286
6. Fowler A.M., Dutton J.J. Floppy eyelid syndrome as a subset of lax eyelid conditions: relationships and clinical relevance (an ASOPRS thesis). Ophthalmic Plast Reconstr Surg. 2010;26(3):195–204. DOI: 10.1097/IOP.0b013e3181b9e37e
7. Криницына Е.А., Фетцер Е.И., Груша Я.О. Патогенетические и клинические аспекты синдрома гиперрастяжимых век (floppy eyelid syndrome). Вестник офтальмологии. 2021;137(1):102–105. DOI: 10.17116/oftalma2021137011102Krinitsyna E.A., Fetzer E.I., Grusha Ya.O. Pathogenetic and clinical aspects of hyperextensible eyelid syndrome (floppy eyelid syndrome). Bulletin of Ophthalmology. 2021;137(1):102–105 (in Russ.). DOI: 10.17116/oftalma2021137011102
8. Leibovitch I., Selva D. Floppy eyelid syndrome: clinical features and the association with obstructive sleep apnea. Sleep Med. 2006;7(2):117–122. DOI: 10.1016/j.sleep.2005.07.001
9. Sleep-related breathing disorders in adults: recommendations for syndrome definition and measurement techniques in clinical research. The Report of an American Academy of Sleep Medicine Task Force. Sleep. 1999;22(5):667–689. PMID: 10450601
10. Garvey J.F., Pengo M.F., Drakatos P., Kent B.D. Epidemiological aspects of obstructive sleep apnea. J Thorac Dis. 2015;7(5):920–929. DOI: 10.3978/j.issn.2072-1439.2015.04.52
11. Woog J.J. Obstructive sleep apnea and the floppy eyelid syndrome. Am J Ophthalmol. 1990;110(3):314–315. DOI: 10.1016/s0002-9394(14)76357-3
12. McNab A.A. Floppy eyelid syndrome and obstructive sleep apnea. Ophthalmic Plast Reconstr Surg. 1997;13:98–114. DOI: 10.1097/00002341-199706000-00005
13. Pedrotti E., Demasi C.L., Bruni E. et al. Prevalence and risk factors of eye diseases in adult patients with obstructive sleep apnoea: Results from the SLE.E.P.Y cohort study. BMJ Open. 2017;7:e016142. DOI: 10.1136/bmjopen-2017-016142
14. Schlötzer-Schrehardt U., Stojkovic M., Hofmann-Rummelt C. et al. The Pathogenesis of floppy eyelid syndrome: involvement of matrix metalloproteinases in elastic fiber degradation. Ophthalmology. 2005;112(4):694–704. DOI: 10.1016/j.ophtha.2004.11.031
15. Netland P.A., Sugrue S.P., Albert D.M. et al. Histopathologic features of the floppy eyelid syndrome. Involvement of tarsal elastin. Ophthalmology. 1994;101:174–181.
16. Parunović A. Floppy eyelid syndrome. Br J Ophthalmol. 1983;67(4):264–266. DOI: 10.1136/bjo.67.4.264
17. Гришина Е.Е., Рябцева А.А., Белова Т.В. Синдром «вялых век». Альманах клинической медицины. 2015;36:71–73. DOI: 10.18786/2072-0505-2015- 36-71-73Grishina E.E., Ryabtseva A.A., Belova T.V. The syndrome of "sluggish eyelids". The Almanac of Clinical Medicine. 2015;36:71–73 (in Russ.). DOI: 10.18786/2072-0505-2015-36-71-73
18. Segev F., Héon E., Cole W.G. et al. Structural abnormalities of the cornea and lid resulting from collagen V mutations. Invest Ophthalmol Vis Sci. 2006;47(2):565–573. DOI: 10.1167/iovs.05-0771
19. Nuruddin M. Management of floppy eyelid associated with Down's syndrome: a case report. Orbit. 2012;31(5):370–372. DOI: 10.3109/01676830.2012.711892
20. Sun S.Y., Pulido J.S., Bartley G.B., Chen J.J. Floppy eyelid syndrome in stickler syndrome. Am J Ophthalmol Case Rep. 2019;14:14–15. DOI: 10.1016/j.ajoc.2019.01.014
21. Ezra D.G., Derriman L., Mellingtion F.E. et al. Spontaneous globe luxation associated with shallow orbits and floppy eyelid syndrome. Orbit. 2008;27(1):55–58. DOI: 10.1080/01676830601174593
22. McNab A.A. Reversal of floppy eyelid syndrome with treatment of obstructive sleep apnoea. Clin Exp Ophthalmol. 2000;28(2):125–126. DOI: 10.1046/j.1442-9071.2000.00278.x
23. Ting R.J.E., Singh N., Ling M., Spencer S.K. et al. Assessment of Obstructive Sleep Apnoea and Sleeping Laterality by Evaluating Upper Eyelid Distraction: A Prospective, Comparative Polysomnographic Study. Cureus. 2020;12(8):e9566. DOI: 10.7759/cureus.9566
24. Iyengar S.S., Khan J.A. Quantifying upper eyelid laxity in symptomatic floppy eyelid syndrome by measurement of anterior eyelid distraction. Ophthalmic Plast Reconstr Surg. 2007;23(3):255. DOI: 10.1097/IOP.0b013e31805819d3
25. Medel R., Alonso T., Vela J.I. et al. Conjunctival cytology in floppy eyelid syndrome: objective assessment of the outcome of surgery. Br J Ophthalmol. 2009;93(4):513–517. DOI: 10.1136/bjo.2008.144287
26. Abenavoli F.M., Lofoco G., DeGaetano C. A technique to correct floppy eyelid syndrome. Ophthalmic Plast Reconstr Surg. 2008;24(6):497–498. DOI: 10.1097/IOP.0b013e31818b7745
27. Ezra D.G., Beaconsfield M., Sira M., Bunce C. et al. Long-term outcomes of surgical approaches to the treatment of floppy eyelid syndrome. Ophthalmology. 2010;117(4):839–846. DOI: 10.1016/j.ophtha.2009.09.009
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