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We examined 11 overweight men, ranging in age from 34 to 56 years, who had the floppy eyelid syndrome, a disorder of unknown origin manifested by an easily everted, floppy upper eyelid and papillary conjunctivitis of the upper palpebral conjunctiva. The upper eyelid everts during sleep, resulting in irritation, papillary conjunctivitis, and conjunctival keratinization. Effective treatment consists of preventing the upper eyelid from everting while the patient is sleeping.

Three patients with increasing swelling of the lateral half of the upper lid associated with chronic papillary conjunctivitis which did not respond to therapy were observed. The history, clinical findings, keratinized epithelial cells in the scrapings and the therapeutic success with a protective shield over night suggested the diagnosis of floppy eyelid syndrome.

The results of clinical examinations and follow-up of 7 patients with floppy eyelid syndrome are presented. The most prominent features of the syndrome are floppy upper eyelids that can be easily everted, with papillary conjunctivitis and punctate keratopathy. The ocular changes seem to be the result of an underlying metabolic (or endocrine) disorder. In the patient with the longest follow-up period (10 years) considerable loss of body weight resulted in a dramatic relief of ocular symptoms.

The authors report a case of unilateral floppy eyelid syndrome with ipsilateral intolerance to brimonidine in a 65-year-old man. The singularity of this case is the combination of two rare illnesses of great phlogistic potentiality in the same eye. The purpose of this article is to report a case of unilateral floppy eyelid syndrome with ipsilateral intolerance to brimonidine, emphasizing a possible relation between them. The result was a unilateral keratopathy that emulated an intraepithelial neoplasia. The key to solving the problem was an unexplained anterior uveitis that raised the suspicion of drug toxicity.The upper eyelid eversion of the affected eye during sleep seemed to be the common denominator of both ailments. The bizarre aspect of the epitheliopathy most likely resulted from the combination of trauma, insufficient lubrication, and drug intolerance.

Four patients (five eyes) with the classic findings of floppy eyelid syndrome all had chronic irritative symptoms, with papillary conjunctivitis, and a soft, rubbery, floppy, and easily everted upper eyelid. All affected eyes were treated surgically by a full-thickness eyelid shortening procedure which produced immediate relief of symptoms. Histopathologic study of the resected eyelids showed only an inflammatory infiltrate in the conjunctiva, but failed to identify specific cause-for the lax tarsus.

A 31-year-old man with spastic paraparesis (diagnosed when he was 10 years old) and hyperglycinemia (diagnosed when he was 19 years old) had an intermittently swollen right eye and blurred vision. His right upper eyelid was S-shaped and edematous, the lateral canthal tendon was flaccid, and the eyelid everted easily. After the floppy eyelid syndrome was diagnosed, the patient underwent a tarsal strip procedure to shorten and tighten the lax upper eyelid. This relieved his symptoms, which have not recurred in the year since surgery.

A 41-year-old obese man presented with bilateral ocular irritation and clinical findings consistent with floppy eyelid syndrome. Light- and electron-microscopic examination of tarsus removed at surgical correction revealed cystic degeneration and squamous metaplasia of the meibomian glands, along with abnormal keratinization and granuloma formation. These findings, not reported before in this syndrome, suggest that meibomian gland dysfunction with attendant qualitative abnormalities of the tear film, may be partly responsible for the keratoconjunctivitis seen in this syndrome.

A case of floppy eyelid syndrome associated with keratotorus is presented. The patient was thoroughly examined and followed up for several years. During that time he developed an acute corneal hydrops. The importance of this association for the better understanding of the syndrome is discussed.

Objective To determine the prevalence of eyelid, conjunctival, and corneal findings in patients with sleep apnea syndrome (SAS). Design Case series. Participants Seventy-two white patients referred for evaluation of suspected SAS. Intervention Complete examination of eyelids, conjunctiva, and cornea, including videokeratography. Main outcome measures Spearman rank correlations were determined between the respiratory disturbance index (RDI) during night sleep, a value used to diagnose and grade SAS, and tear film break-up time, eyelid distraction distance, presence or absence of ocular irritation symptoms, blepharoptosis, floppy eyelids, lacrimal gland prolapse, keratoconus, and endothelial dystrophy. Each correlation was controlled for age and body mass index. Results According to the RDI, 44 (61%) of the 72 patients had SAS. The RDI correlated positively with the eyelid distraction distance ( P = 0.05), presence or absence of floppy eyelids ( P = 0.01), and lacrimal gland prolapse ( P = 0.01), and correlated negatively with tear film break-up time ( P = 0.02). None of our patients with floppy eyelids had corneal abnormalities. One patient with SAS had bilateral keratoconus; another had bilateral Fuch endothelial dystrophy. Conclusions Sleep apnea syndrome was significantly associated with reduced tear film break-up time, floppy eyelids, and lacrimal gland prolapse. However, ocular irritation symptoms and corneal involvement were rare among patients with SAS. These findings do not confirm previous studies that reported a high prevalence of corneal involvement in floppy eyelid syndrome.