Floppy Eyelid Syndrome

Floppy eyelid syndrome (FES) is considered a common and under-diagnosed eyelid syndrome. FES is characterized by a loose or “floppy” eyelid that easily contorts or everts without spontaneously returning to its normal shape. Typical presenting symptoms include tearing, irritation, photosensitivity, and foreign body sensation in the eye. Signs include swelling, discharge, and papillary conjunctivitis. Despite these often-common signs and symptoms, FES remains a poorly defined eyelid disorder. First described in 1984, FES was first seen in a group of mostly men with high BMI who presented with eyelid laxity and papillary conjunctivitis.  Other terms, such as “lax eyelid syndrome” (LES), have been used. There is a distinction between these terms, as LES refers to known causes of eyelid laxity. These include “paralytic LES” (cranial nerve VII palsy), mechanical forces that disrupt the lateral canthal ligament, or involutional changes of the lateral canthal ligament or canthus unrelated to mechanical forces. When eyelid laxity presents as an isolated condition apart from other ocular surface diseases (OSD) or papillary conjunctivitis, it is termed “lax eyelid condition” (LAC). FES is a term used to describe a subset of patients within the larger classification of LES, predominantly men of middle age with high BMIs presenting with papillary conjunctivitis. Additionally, there is a strong correlation between the prevalence of patients with FES and obstructive sleep apnea (OSA).  Therefore, the terms FES, LES, and LAC should not be used interchangeably. A careful history of past medical and ocular diseases, risk factors, time of presentation, and presenting signs and symptoms can aid in properly diagnosing floppy eyelid syndrome.