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Study finds link between floppy eyelid syndrome and obstructive sleep apnea

Ophthalmology. 2010;117(4):831-838.

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A high percentage of patients diagnosed with floppy eyelid syndrome suffered from obstructive sleep apnea, a study found. Floppy eyelid syndrome was also linked to keratoconus and other disorders.

"Floppy eyelid syndrome is a condition strongly associated with [obstructive sleep apnea-hypopnea syndrome] and keratoconus," the study authors said. "As well as providing a platform for an etiologic hypothesis for the condition, these findings should encourage clinicians to be aware of these associations and to direct further treatment."

The case-controlled study included 102 patients with floppy eyelid syndrome and 102 matched controls. Patients in the floppy eyelid syndrome group had a mean age of 50.4 years and body mass index (BMI) of 37.8. Subjects in the control group had a mean age of 53.6 years and BMI of 37. Patients were matched based on BMI, age and gender.

All patients underwent assessment of upper and lower lid laxity and upper lid levator function, and keratoconus was graded. The Epworth daytime somnolence score was used to screen for obstructive sleep apnea-hypopnea syndrome (OSAHS).

Primary outcome measures were degree of association between floppy eyelid syndrome and keratoconus, OSAHS, smoking history and lid status.

Study data showed that 32 patients in the floppy eyelid syndrome group had OSAHS. Nine subjects in the control group had OSAHS. Results showed statistically significant correlations between floppy eyelid syndrome and OSAHS (P = .0008), keratoconus (P < .0001), upper lid medial canthal laxity (P = .02), upper lid distraction (P = .001) and levator function (P = .005).

The authors found a strong correlation between floppy eyelid syndrome and preferred sleeping side. The results also suggested that people with OSAHS may have an impaired nervous system response that prevents them from waking when breathing slows or stops or when the eyelid is under high stress.

Floppy eyelid syndrome was also associated with keratoconus, which may be attributed to frequent eye rubbing, the authors said.

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