What is Floppy Eyelid Syndrome and How is it Related to Sleep Apnea?

I talk to many people I encounter in my day-to-day activities about sleep apnea. Recently, I went for my routine eye check and my opthamolgist told me that he can diagnose sleep apnea too!

Most often, he has discovered sleep apnea when one of his patients is sedated for surgery, but less often he sees an eye disorder that is almost always associated with sleep apnea, called floppy eye syndrome.

 

What is floppy eyelid syndrome?

Floppy eyelid syndrome (FES) is an eye disorder that is under-diagnosed. Symptoms include irritation and itching of they eyes, especially upon waking.

The disorder is characterized by the eyelids becoming loose and rubbery and easily flipping over, like when rolling over in bed and the eyelid comes in contact with the pillow.

Who gets floppy eyelid syndrome?

It is most common in overweight, middle-aged men, similar to sleep apnea (learn more about risk factors for sleep apnea here). 

It is associated with keratoconus (visual distortions like ghosting, multiple images, glare, halos, or blurred vision) and lash ptosis (eyelashes that point out from the eye horizontally or downward).

How is floppy eyelid syndrome related to sleep apnea?

A 2010 study looked at 102 patients with FES and a control group of another 102 patients. 90% of study participants with FES also had obstructive sleep apnea.

A 2012 study of 127 people suspected of having obstructive sleep apnea found that 25.8% of those with OSA also had FES and of those with more severe OSA (AHI over 30, learn about AHI here), 40% had FES. The researchers concluded that severe OSA may be an independent risk factor for FES.

Researchers aren’t exactly sure why. In addition to shared risk factors (obesity, age), it could be that those with OSA have greater tissue elasticity which also affects incidence of FES,

According to Dr. Brad Sutton, OD, FAAO, of the Indiana University School of Optometry, “The incidence of sleep apnea in patients with floppy eyelid syndrome (FES) is essentially 100%.”

Dr. Sutton urges his patients with FES to get tested for sleep apnea.

How is floppy eye syndrome treated?

FES is often treated as eye irritation with drops before the patients are properly diagnosed. However, finding out if the patient has sleep apnea and then treating the sleep apnea is the best approach as this will likely improve the FES.

Dr. Sutton’s treatment approach is three parts:

  1. Using a thick lubricating ointment at night.
  2. Sleeping with a cylindrical pillow to minimize contact with the eye and the pillow at night.
  3. Wearing a firm sleep mask or taping the eyelids down to prevent eversion (flipping).

If those treatments don’t work, surgery to tighten the eyelid tissue may be required.

If you or a loved one suffers from floppy eye syndrome, talk to your doctor. If you suspect that you suffer from sleep apnea, we can help.

Request sleep study

Sources:

  • Chambe, Juliette, et al. “Floppy eyelid syndrome is associated with obstructive sleep apnoea: a prospective study on 127 patients.” Journal of sleep research 21.3 (2012): 308-315.
  • Ezra, Daniel G., et al. “The associations of floppy eyelid syndrome: a case control study.” Ophthalmology117.4 (2010): 831-838.
  • http://www.healio.com/optometry/primary-care-optometry/news/online/%7Beaa4699c-6917-4c7f-ba59-ac01b7d01e6b%7D/speaker-suspect-sleep-apnea-in-all-cases-of-floppy-eyelid-syndrome

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Comments

  1. orthea harcum Reply

    i have floppy eyelids i use a cpap

  2. Bev Tiding Reply

    Seems like plastic surgeons who are frequently sought out for upper blepharoplasties should be strongly counseling these patients to have OSA testing.

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