Floppy eyelid syndrome correlates strongly with sleep apnea, keratoconus
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The association between floppy eyelid syndrome and obstructive sleep apnea is so prevalent that every patient who is diagnosed with the syndrome should automatically be evaluated for sleep apnea, a speaker said.
“Any time you see someone with floppy eyelid, it should be your first documentation in their chart as well as a discussion with the patient to make sure they have an evaluation for obstructive sleep apnea. The association is so high it’s imperative to get this,” Lisa M. Nijm, MD, said during the corneal health roundtable at the virtual OSN New York meeting.
Eric D. Donnenfeld, MD, who moderated the discussion, said the syndrome is almost an “epidemic” and is highly associated with keratoconus. Typically, ophthalmologists can expect the eye with the worse floppy eyelid syndrome to have the worse keratoconus because that is the side the patient typically sleeps on.
The roundtable participants evaluated the treatment course of a 55-year-old woman with a 5-mm epithelial defect and increasing eye pain. The patient had normal corneal sensation, no history of trauma or viral infection, and no lagophthalmos. After evaluating the patient, Donnenfeld said floppy eyelid syndrome was evident despite the presence of an epithelial defect.
“Usually patients who have floppy eyelid syndrome don’t get epithelial defects,” he said.
Henry D. Perry, MD, said patients with floppy eyelid syndrome who also present with an epithelial defect may not have Bell’s phenomenon. In these patients a forced lid closure evaluation should be performed.
Good Bell’s phenomenon usually protects the cornea, so this evaluation should be performed to identify patients at high risk, Donnenfeld said.
“The patients who get in trouble are the patients who have poor Bell’s phenomenon. Always check for Bell’s phenomenon when any patient has any type of exposure problem. That will dictate your therapy,” Donnenfeld said.
Perry also said the syndrome is so prevalent he begins all external exams by evaluating for floppy eyelid syndrome, not with a slit lamp examination.
Regardless of body habitus, every patient should be evaluated for floppy eyelid syndrome, according to Kenneth R. Kenyon, MD.
“You have to look for it in every patient,” Kenyon said.
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Donnenfeld ED, et al. Corneal health roundtables. Presented at: OSN New York and OSN New York Retina; Oct. 17-18, 2020 (virtual meeting).
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