head JofIMAB
Journal of IMAB - Annual Proceeding (Scientific Papers)
Publisher: Peytchinski Publishing Ltd.
ISSN: 1312-773X (Online)
Issue: 2019, vol. 25, issue2
Subject Area: Medicine
DOI: 10.5272/jimab.2019252.2481
Published online: 10 April 2019

Original article

J of IMAB. 2019 Apr-Jun;25(2):2481-2485
Alexander Donchev1ORCID logo, Mario Milkov2ORCID logo Corresponding Autoremail,
1) Depatrtment International Cooperation, Medical University Varna, Bulgaria.
2) Faculty of Dental Medicine, Medical University, Varna, Bulgaria.

In this concise review, some essential characteristics of a relatively rare ocular disorder, floppy eyelid syndrome, are described. A special emphasis is made on the close relationships between this eye disease, on the one hand, and obstructive sleep apnea designed as a common and socially significant pathology of modern society, on the other hand. Along with conservative drug treatment, a variety of effective surgical techniques for the treatment of floppy eyelid syndrome are presented. A closer collaboration between ophthalmologists and sleep medicine specialists is needed to solve the problems of obstructive sleep apnea-related floppy eyelid syndrome.

Keywords: floppy eyelid syndrome, diagnosis, treatment, obstructive sleep apnea, comorbidity,

pdf - Download FULL TEXT /PDF 489 KB/
Please cite this article as: Donchev A, Milkov M. Floppy eyelid syndrome and obstructive sleep apnea. J of IMAB. 2019 Apr-Jun;25(2):2481-2485. DOI: 10.5272/jimab.2019252.2481

Corresponding AutorCorrespondence to: Assoc. Prof. Mario Milkov, MD, PhD. Department of Dental Materials Science and Propaedeutics of Prosthetic Dental Medicine, Faculty of Dental Medicine, Medical University Prof. Paraskev Stoyanov of Varna; 55, Marin Drinov Str., 9002 Varna, Bulgaria ; E-mail: mariomilkov@gmail.com

1.  1. Santos M, Hofmann RJ. Ocular Manifestations of Obstructive Sleep Apnea. J Clin Sleep Med. 2017 Nov 15;13(11):1345-1348. [PubMed] [Crossref]
2. Parunovic A. Floppy eyelid syndrome. Br J Ophthalmol. 1983;67(4):264-266.
3. Culbertson WW, Ostler HB. The floppy eyelid syndrome. Am J Ophthalmol. 1981;92(4):568-575.
4. Miyamoto C, Espirito Santo LC, Roisman L, Moreno Pde A, Cariello AJ, Osaki MH. Floppy eyelid syndrome: review. Arq Bras Oftalmol. 2011;74(1):64-66. 
5. Ezra DG, Beaconsfield M, Collin R. Floppy eyelid syndrome: stretching the limits. Surv Ophthalmol. 2010 Jan-Feb;55(1):35-46.
6. Schlotzer-Schrehardt U, Stojkovic M, Hofmann-Rummelt C, Cursiefen C, Kruse FE, Holbach LM. The pathogenesis of floppy eyelid syndrome: involvement of matrix metalloproteinases in elastic fiber degradation. Ophthalmology. 2005;112(4):694-704.  
7. Leibovitch I, Selva D. Floppy eyelid syndrome: clinical features and the association with obstructive sleep apnea. Sleep Med. 2006;7(2):117-122.
8. Liu DT, Di Pascuale MA, Sawai J, Gao YY, Tseng SC. Tear film dynamics in floppy eyelid syndrome. Invest Ophthalmol Vis Sci. 2005;46(4):1188-1194.
9. Hashemi H, Rastad H, Emamian MH, Fotouhi A. Floppy eyelid syndrome and its determinants in Iranian adults: a population-based study. Eye Contact Lens. 2017 Nov;43(6):406-410.
10. Jordan AS, McSharry DG, Malhotra A. Adult obstructive sleep apnoea. Lancet. 2014;383(9918):736-747. 
11. Randerath W, Bassetti CL, Bonsignore MR, Farre R, Ferini-Strambi L, Grote L, et al. Challenges and perspectives in obstructive sleep apnoea: Report by an ad hoc working group of the Sleep Disordered Breathing Group of the European Respiratory Society and the European Sleep Research Society. Eur Respir J. 2018 Sep 16;52(3). [PubMed] [Crossref]
12. Fietze I, Laharnar N, Obst A, Ewert R, Felix SB, Garcia C, et al. Prevalence and association analysis of obstructive sleep apnea with gender and age differences - Results of SHIP-Trend. J Sleep Res. 2018 Oct 1:e12770. [PubMed] [Crossref]
13. Moscato EE, Jian-Amadi A. Floppy eyelid syndrome. Compr Ophthalmol Update. 2007 Mar-Apr;8(2):59-65.
14. Muniesa M, March A, Sбnchez-de-la-Torre M, Huerva V, Jurjo C, Barbй F, et al. Corneal biomechanical properties in floppy eyelid syndrome. Cornea. 2015 May;34(5):521-524.
15. Belliveau MJ,  Harvey JT. Floppy eyelid syndrome. CMAJ. 2015 Feb 3;187(2):130.
16. Ezra DG, Beaconsfield M, Sira M, Bunce C, Wormald R, Collin R. The associations of floppy eyelid syndrome: a case control study. Ophthalmology. 2010a;117(4):831-838.
17. McNab AA. The eye and sleep apnea. Sleep Med Rev. 2007;11(4):269-276.
18. Skorin L Jr, Knutson R. Ophthalmic diseases in patients with obstructive sleep apnea. J Am Osteopath Assoc. 2016 Aug 1;116(8):522-529.
19. Muniesa MJ, Huerva V, Sбnchez-de-la-Torre M, Jurjo C, Barbй F. The relationship between floppy eyelid syndrome and obstructive sleep apnoea. Br J Ophthalmol. 2013;97(11):1387-1390. 
20. Chambe J, Laib S, Hubbard J, Erhardt C, Ruppert E, Schroder C, et al. Floppy eyelid syndrome is associated with obstructive sleep apnoea: a prospective study on 127 patients. J Sleep Res. 2012 Jun;21(3):308-315.
21. West SD, Turnbull C. Obstructive sleep apnoea. Eye (Lond). 2018 May;32(5):889-903.
22. Wang P, Yu DJ, Feng G, Long ZH, Liu CJ, Li H, et al. Is floppy eyelid syndrome more prevalent in obstructive sleep apnea syndrome patients? J Ophthalmol. 2016; 2016:6980281. [PubMed] [Crossref]
23. Huon LK, Liu SY, Camacho M, Guilleminault C. The association between ophthalmologic diseases and obstructive sleep apnea: a systematic review and meta-analysis. Sleep Breath. 2016 Dec;20(4):1145-1154.
24. Sward M, Kirk C, Kumar S, Nasir N, Adams W, Bouchard C. Lax eyelid syndrome (LES), obstructive sleep apnea (OSA), and ocular surface inflammation. Ocul Surf. 2018 Jul;16(3):331-336.
25. Dhillon PS, Lewis G. Floppy eyelid syndrome. BMJ Case Rep. 2015 Jul 2;2015. [PubMed] [Crossref]
26. Periman LM, Sires BS. Floppy eyelid syndrome: a modified surgical technique. Ophthalmic Plast Reconstr Surg. 2002;18(5):370-372.
27. Ezra DG, Beaconsfield M, Sira M, Bunce C, Shah-Desai S, Verity DH, et al. Long-term outcomes of surgical approaches to the treatment of floppy eyelid syndrome. Ophthalmology. 2010;117(4):839-846.
28. Valenzuela AA, Sullivan TJ. Medial upper eyelid shortening to correct medial eyelid laxity in floppy eyelid syndrome: a new surgical approach. Ophthalmic Plast Reconstr Surg. 2005 Jul;21(4):259-263.
29. Lee CC, Lai HT, Kuo YR, Lee SS, Lai CS. Floppy eyelid syndrome: an unfamiliar entity for plastic surgeons. Ann Plast Surg. 2018 Feb;80(2S Suppl 1):S40-S47.
30. Bayır Ö, Acar M, Yüksel E, Yüceege M, Saylam G, Tatar EÇ, et al. The effects of anterior palatoplasty on floppy eyelid syndrome patients with obstructive sleep apnea. Laryngoscope. 2016 Sep;126(9):2171-2175.
31. Compton CJ, Melson AT, Clark JD, Shipchandler TZ, Nunery WR, Lee HB. Combined medial canthopexy and lateral tarsal strip for floppy eyelid syndrome. Am J Otolaryngol. 2016 May-Jun;37(3):240-244.
32. Huerva V, Muniesa MJ, Ascaso FJ. Floppy eyelid syndrome in obstructive sleep apnea syndrome. Sleep Med. 2014;15:724-727. 
33. Kymionis GD, Grentzelos MA, Liakopoulos DA, Kontadakis GA, Stojanovic N. Corneal collagen crosslinking failure in a patient with floppy eyelid syndrome. J Cataract Refract Surg. 2014 Sep;40(9):1558-1560.
34. Chandravanshi SL, Rathore MK, Tirkey ER. Congenital combined eyelid imbrication and floppy eyelid syndrome: case report and review of literature. Indian J Ophthalmol. 2013 Oct;61(10):593-596.     
35. Brown MD, Potter JW. Floppy eyelid syndrome: a case report and clinical review. J Am Optom Assoc. 1992;63(5):309-314.
36. West SD, Turnbull C. Eye disorders associated with obstructive sleep apnoea. Curr Opin Pulm Med. 2016 Nov;22(6):595-601.

Received: 21 December 2018
Published online: 12 April 2019

back to Online Journal