Case Reports

An extreme floppy eyelid syndrome case: surgery and effect on ocular surface

Case Report Details

First Author: M.Acar TURKEY

Co Author(s):                        

Abstract Details

Purpose:

To report a case of an extreme floppy eyelid syndrome(FES) case, correction surgery and effect on ocular surface.

Setting:

This was a case report and desinged at Department of Ophthalmology, University of Health Sciences, Diskapi Yildirim Beyazit Training and Research Hospital, Ankara, Turkey.

Report of Case:

A 46‑year‑old male patient referred to our clinic with complaints of left eye irritation and discharge. He was brought to the clinic by his partner after she had noticed eversion of his left eyelid during sleeping. His medical history revealed obstructive sleep apnea syndrome (OSAS). He could not do the positive airway pressure therapy effectively. Uncorrected visual acuity was found 20/20 in both eyes. Biomicroscopy revealed superficial punctate epithelial defect; and the external examination showed a significant spontaneously eversion of the left upper eyelid with minimal upward traction. Treatments given for the ocular surface did not relieve the patient and clinical findings. Correction surgery was decided for FES. Lateral vertical pentagonal upper eyelid resection was appliedin the left eye. Eye examination was repeated a month after surgery. Pre-surgery(PS) and after-surgery(AS) Ocular Surface Disease Index (OSDI) result was 86.36 and 36.36 respectively. Tear film break-up time (TBUT) value was PS and AS 4 and 7 seconds. Scores of the corneal staining stages was PS and AS 4 and 1, according to the Oxford scheme, respectively. His FES seemed almost absent.

Conclusion/Take Home Message:

FES is associated with OSAS. FES is also associated with easily everted floppy eyelids, papillary conjunctivitis and recurrent corneal epithelial erosions. FES manifests with the symptoms of stinging, burning, itching, tearing, and redness. This impairment in the ocular surface leads to symptoms such as burning, staining, redness, and blurred vision. If such ocular complaints which can be commonly observed in middle-aged patients, are accompanied by ocular surface findings and the presence of FES, the sleeping pattern of the patient should be evaluated and the patient should be referred to the sleep disorders unit in case of suspicion. Correction eyelid surgery should be considered quickly in this syndrome rather than spending long time on ocular surface treatment.

Financial Disclosure:

None