Department of Ophthalmology, University of California San Francisco.
Ophthalmology Section, Surgical Service, San Francisco Veterans Affairs Medical Center, San Francisco, California, USA.
Curr Opin Ophthalmol. 2019 Nov;30(6):513-524. doi: 10.1097/ICU.0000000000000617.
To summarize the ocular and systemic associations of floppy eyelid syndrome (FES) as well as provide an up-to-date review on the pathogenesis and treatment strategies.
Virtually all patients with FES have obstructive sleep apnea (OSA). However, a significantly lower proportion of patients with OSA have FES. Although some studies demonstrate no association between OSA and FES, almost all show at least an association with increased eyelid laxity, which may be a less severe form of FES. FES has also been associated with keratoconus (KCN) and glaucoma. Decreased corneal hysteresis has been found in FES, KCN, glaucoma, and OSA and may be related to matrix metalloproteinase (MMP) upregulation. Hypoxia-reperfusion injury, leptin resistance, and mechanical forces all may lead to increased MMP activity, contributing to elastin breakdown in the tarsus and other tissues throughout the body. Management of FES begins with investigation for OSA. Treating OSA with continuous positive airway pressure (CPAP) or surgical uvulopalatoplasty may improve FES. Surgical treatments for FES should reduce horizontal eyelid laxity while maximizing the stability of the tarsus. Collagen crosslinking may prove a helpful modality for stabilizing the tarsus in the future.
FES is associated with OSA, glaucoma, and KCN. MMP upregulation and lower corneal hysteresis have been found in these conditions, pointing toward a potential common pathogenesis.
总结眼睑松弛综合征（FES）的眼部和全身相关性，并对其发病机制和治疗策略进行最新回顾。
几乎所有 FES 患者均存在阻塞性睡眠呼吸暂停（OSA）。然而，仅有比例较小的 OSA 患者存在 FES。尽管一些研究表明 OSA 和 FES 之间无关联，但几乎所有研究均表明二者至少与眼睑松弛度增加相关，这可能是 FES 的一种较轻形式。FES 还与圆锥角膜（KCN）和青光眼相关。FES、KCN、青光眼和 OSA 患者的角膜滞后量均降低，这可能与基质金属蛋白酶（MMP）上调有关。缺氧再灌注损伤、瘦素抵抗和机械力均可能导致 MMP 活性增加，导致睑板和全身其他组织中的弹性蛋白分解。FES 的治疗首先要调查 OSA。使用持续气道正压通气（CPAP）或手术悬雍垂腭咽成形术治疗 OSA 可能改善 FES。FES 的手术治疗应减少水平眼睑松弛度，同时最大限度地稳定睑板。未来交联胶原可能成为稳定睑板的一种有用方式。
FES 与 OSA、青光眼和 KCN 相关。这些情况下发现 MMP 上调和较低的角膜滞后量，表明存在潜在的共同发病机制。
