Survey of Ophthalmology
Volume 55, Issue 1 , Pages 35-46, January 2010

Floppy Eyelid Syndrome: Stretching the Limits

  • Daniel G. Ezra, MA, MRCS, MRCOphth

      Affiliations

    • Adnexal Department, Moorfields Eye Hospital NHS Foundation Trust, London, United Kingdom
    • Department of Cell Biology, UCL Institute of Ophthalmology, London, United Kingdom
    • NIHR Biomedical Research Center for Ophthalmology, Moorsfields Eye Hospital and UCL Institute of Ophthalmology, Moorsfields Eye Hospital, London, United Kingdom
    • Corresponding Author InformationReprint address: Mr. Daniel G Ezra, MA, MRCS, MRCOphth, Adnexal Department, Moorfields Eye Hospital, City Road, London EC1V 2PD, United Kingdom.
  • ,
  • Michèle Beaconsfield, FRCS, FRCOphth

      Affiliations

    • Adnexal Department, Moorfields Eye Hospital NHS Foundation Trust, London, United Kingdom
  • ,
  • Richard Collin, MA, FRCS, FRCOphth

      Affiliations

    • Adnexal Department, Moorfields Eye Hospital NHS Foundation Trust, London, United Kingdom

published online 12 October 2009.

Abstract 

Floppy eyelid syndrome is a distressing condition that can cause significant morbidity and vision loss. Many systemic and ocular associations have been proposed, most notably keratoconus and obstructive sleep apnea-hypopnea syndrome. Although conservative treatments can sometimes be effective, a wide variety of surgical treatments to tighten the upper eyelid have been described. The underlying pathogenesis remains elusive, although progress has been made in the identification of extracellular matrix changes in the tarsal plate. This systematic review discusses the issues surrounding ambiguities in the definition of floppy eyelid syndrome as well as what is currently known about its clinical features, ocular and systemic associations, pathological changes, and proposed theories of pathogenesis. In addition a critical discussion of the proposed surgical treatments and their reported success rates and follow-up times is provided.

Key words: conjunctivitis, elastin, floppy eyelid syndrome, keratoconus, sleep apnea

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 This review forms part of a thesis for the degree of Doctor of Medicine submitted to Cambridge University. This study was funded by the special trustees of Moorfields Eye Hospital. The authors acknowledge a proportion of their financial support from the Department of Health through the award made by the National Institute for Health Research to Moorfields Eye Hospital NHS Foundation Trust and UCL Institute of Ophthalmology for a Specialist Biomedical Research Centre for Ophthalmology. The views expressed in this publication are those of the authors and not necessarily those of the Department of Health.The authors reported no proprietary or commercial interest in any product mentioned or concept discussed in this article.

PII: S0039-6257(09)00139-8

doi:10.1016/j.survophthal.2009.02.025

Refers to erratum:

Survey of Ophthalmology
Volume 55, Issue 1 , Pages 35-46, January 2010