What is Floppy Eyelid Syndrome?

Floppy eyelid syndrome (FES) is a relatively common and under-diagnosed condition. It is characterized by gradually worsening laxity of the upper eyelids that results in eye irritation because tears are poorly distributed with blinking. In addition, the laxity leads to the eyelids easily turning inside out with eye rubbing and even with sleeping. People with FES may also experience chronic bouts of  pink eye (also known as conjunctivitis) which including the development of bumps on the inner surface of the eyelid. Due to the turning-over of the eyelid when sleeping, FES may result in frequent redness and eye irritation upon waking.

Untreated FES may be associated with the following:

  • Chronic eye irritation and redness
  • Tearing and worsening of eye irritation in the mornings
  • Mattering or discharge from the eyes
  • Droopy upper eyelids
  • Infection of the cornea (keratitis)
  • Corneal ulceration
  • Scarring
  • Eyelashes that droop into the line of vision
  • A loose and unstable lower eyelid

What causes Floppy Eyelid Syndrome?

Research studies have identified a few factors that may contribute to the development of floppy eyelid syndrome.

  • Insufficient elastin in the eyelid. Floppy eyelid syndrome doesn’t just involve the skin. The tarsal plate, a layer of thick connective tissue, and the tendons that connect the eyelids to the eye socket (orbital) bones are also affected. Elastin is the natural chemical that helps the skin stay stretchy and elastic. It is what allows the skin to retract after being stretched. Elastin may be compromised by persistent mechanical stress. Studies indicate that patients with floppy eyelid syndrome tend to sleep face-down and usually have worse laxity with the side on which they typically sleep.
  • Obstructive sleep apnea, OSA, is a common condition that occurs alongside floppy eyelid syndrome. This sleep disorder involves momentary pauses in breathing while asleep. Most people with floppy eyelids also have obstructive sleep apnea, although it may be undiagnosed. If your ophthalmologist finds that you have FES, you should discuss the possibility of sleep apnea with your primary care provider, who may order sleep studies for further evaluation. This problem may be more common at higher altitudes and can contribute to feeling sleepy or lethargic during the day.

What are the treatment options for Floppy Eyelid Syndrome?

Treatment for floppy eyelid syndrome is developed based on the severity of the condition. Historically, patients have been advised to use a lubricating eye ointment to decrease irritation and to wear eye shields when sleeping to prevent the eyelids from turning over. When these strategies are ineffective or impractical, many patients seek to repair the functional problem with surgery.

Floppy Eyelid Syndrome Case Study

Floppy Eyelid Syndrome causes excessive upper eyelid laxity permits easy eversion (flipping the eyelid inside out) in a young person with obstructive sleep apnea. You can also notice both the Eyelid and eyelashes drooping.

 

What Is Floppy Eye Surgery?

Dr. Fante and Dr. Goecks performs horizontal tightening procedures to restore proper tension laxity to the upper eyelids. Horizontal tightening may be achieved with tightening of the tendons (known as canthopexy or canthoplasty) or by removing some of the loose tissue to tighten the eyelids (known as the wedge excision technique). Each procedure may take about an hour to complete for both eyes. Patients usually undergo horizontal tightening with a local anesthetic and A mild sedative, typically at an ambulatory surgery center.

Canthopexy or canthoplasty are performed through a small incisions at the outer corner of the eyes. The outer eyelid is repositioned and secured to the lateral eye socket rim, resulting in a tightening and increased stability to decrease the risk of future eversion.

The wedge-excision technique removes a precise pattern of loose full thickness eyelid tissue to restore a smooth, firm eyelid that fits against the globe of the eye. Stitches are placed very carefully to maintain normal contours, smooth inner surfaces, and hidden scars. This procedure sometimes also corrects droopiness of the upper eyelid.

How long will results from Floppy Eyelid Surgery last?

The surgical repair of FES is intended to permanently reduce persistent eye irritation and also preserve the surface of the eye. Studies indicate that surgical tightening, along with the proper management of obstructive sleep apnea, if applicable, can significantly decrease the risk of FES recurrence. That said, because every patient’s biology and lifestyle is unique, there is a possibility of subsequent recurrence years after surgery.

How can I prepare for Floppy Eyelid Surgery?

To properly address floppy eyelid syndrome, you can schedule a consultation with a board-certified oculoplastic surgeon. Dr. Fante and Dr. Goecks have served the Denver area for many years, and are members of the American Society of Ophthalmic Plastic and Reconstructive Surgery. Their exemplary training and extraordinary knowledge pair wonderfully with their insistence on customizing care for each patient. If you are a candidate for surgical intervention, you will receive pre-surgical guidelines to help you prepare for your procedure. If you have any questions before your surgery, please do not hesitate to contact us.

In addition to navigating treatment to restore eyelid function, it is beneficial to also address the systemic condition that may exacerbate floppy eyelid syndrome. Studies have shown that the recurrence of FES decreases when patients receive CPAP treatment for obstructive sleep apnea. If you have been diagnosed with the sleep disorder, it is crucial that you comply with your management protocol. If you have FES, you should be evaluated for the possibility that you might have sleep apnea.

Finally, because surgical procedures are performed using sedation, you will need to arrange to have someone bring you to your surgery and see you safely home.

What is the recovery like after Floppy Eyelid Surgery?

Recovery from eyelid surgery is generally brief with visible swelling and bruising for 1-2 weeks, rapid return of normal vision, and mild discomfort. You may take prescription pain medication for a few days if needed. Many patients can manage comfort with an over-the-counter pain reliever. Talk to the office about which medications are suitable and which should be avoided. To prevent disruption to the eyelid, you may be advised to wear an eye mask when sleeping and to avoid sleeping on your stomach.

Schedule a Consultation

Floppy eyelid syndrome can be a concerning condition. With proper care, there is a good chance that chronic eye redness and irritation can be improved and that further eversion of the eyelids can be prevented for years to come. If you would like to obtain an accurate diagnosis for frequently-turning eyelids, call (303) 839-1616 to schedule a consultation today!