Study: Floppy Eyelid Syndrome. Yup.

Yes, floppy eyelid syndrome (FES) is a technical term.

Yes, it is a “thing”.

At the Dry Eye Shop we often get patients referred by their doctors for some form of night protection for FES. It’s not unusual for the caller (usually male) to have been told this term and to be anywhere from embarrassed to incredulous that this is what it’s called.

Nevertheless, it is, in fact, a thing. It is also challenging. Most of the people I talk to that are actually diagnosed with FES are face sleepers - and their lids, already lax, are rubbing on the pillows. Possibly corneas too. Yikes! Moisture goggles are great for back and side sleepers but it’s a lot harder to sleep comfortably, on your face, with a goggle on. So we have to get creative sometimes. If you’re reading this and need ideas, I have a bunch of videos on YouTube. Then there’s all the CPAP users, which introduces more issues, because whatever we use has to be compatible with the CPAP mask.

Floppy eyelid syndrome: A comprehensive review. Salinas R, Puig M, Fry CL, Johnson DA, Kheirkhah A. Ocul Surf. 2019 Oct 5. pii: S1542-0124(19)30218-6.

Floppy eyelid syndrome (FES) is defined as eyelid hyperlaxity with reactive palpebral conjunctivitis. It is a common condition that can be associated with significant ocular irritation. FES presents with easily everted eyelids and chronic papillary conjunctivitis in the upper eyelids. It is frequently associated with ocular and systemic diseases, notably keratoconus and obstructive sleep apnea, respectively. This comprehensive review describes the epidemiology, pathological changes, proposed pathogenesis, clinical manifestations, and a variety of treatment options for this condition. Conservative treatment of FES includes aggressive lubrication, nighttime eye shield, and avoiding sleeping on the affected eye. Patients with FES and obstructive sleep apnea may have an improvement in their ocular signs and symptoms after long-term therapy with continuous positive airway pressure. In refractory cases, a corrective surgery that addresses the eyelid laxity can result in significant improvement. All patients with ocular irritation should be evaluated for the presence of FES.