Search Our Scientific Publications & Authors

Transl Vis Sci Technol 2021 Apr;10(5)

Department of Ophthalmology and Visual Sciences, Albert Einstein College of Medicine, Montefiore Medical Center, Bronx, NY, USA.

Purpose: Surgery is the standard treatment for floppy eyelid syndrome, but crosslinking (CXL) tarsus has recently been proposed as an alternative. To the best of our knowledge, this study is the first to use second-harmonic generation (SHG) microscopy to examine tarsal collagen ex vivo before and after photo-activated crosslinking. To quantify crosslinking, this study examined fluorescence recovery after photobleaching (FRAP), which indirectly measures tissue stiffness. Read More

J AAPOS 2021 May 5. Epub 2021 May 5.

Department of Pediatric Ophthalmology and Strabismus, Sankara Nethralaya, Chennai, Tamil Nadu, India.

In congenital eyelid imbrication syndrome, a rare condition, the upper eyelids override the lower lids. It has been described in the literature either as an isolated entity or associated with floppy eyelid syndrome. We report the case of a 2-month-old with congenital eyelid imbrication syndrome associated with complex microphthalmos in the same eye and persistent fetal vasculature in the other eye, with no other systemic abnormality. Read More

Int J Dermatol 2021 Mar 4. Epub 2021 Mar 4.

Dermatology Unit, Department of Mental and Physical Health and Preventive Medicine, University of Campania Luigi Vanvitelli, Naples, Italy.

Vestn Oftalmol 2021 ;137(1):102-105

I.M. Sechenov First Moscow State Medical University (Sechenov University), Moscow, Russia.

Floppy eyelid syndrome is rarely diagnosed nowadays. Most patients remain without the correct diagnosis for a long time, which means they do not receive adequate treatment. This syndrome is known to be accompanied by many concomitant clinical manifestations complicating the diagnostic search. Read More

Turk J Ophthalmol 2020 12;50(6):356-361

Ege University Faculty of Medicine, Department of Chest Diseases, İzmir, Turkey.

Objectives: To evaluate periorbital tissue alterations including eyelid laxity and eyelash ptosis in patients with obstructive sleep apnea syndrome (OSAS).

Materials And Methods: Based on polysomnography, 96 eyes of 48 patients with moderate/severe OSAS (Group 1) and 44 eyes of 22 patients with simple snoring (Group 2) were enrolled. Comprehensive eye examination along with eyelid laxity measurements including vertical and anterior distraction, presence of dermatochalasis, interpalpebral distance, and levator function were assessed. Read More

Rom J Ophthalmol 2020 Jul-Sep;64(3):261-268

"Marius Nasta" Pneumophtisiology Institute, Bucharest, Romania; "Carol Davila" University of Medicine and Pharmacy, Bucharest, Romania.

The purpose of this study was to describe the ophthalmological findings in patients with obstructive sleep apnea syndrome (OSAS). The study group was made up of 65 patients with OSAS diagnosis and the findings were compared with the ones of the control group (n=39), which comprised patients without OSAS. An observational, analytic study, with a transversal component and a prospective component, was performed. Read More

Asia Pac J Ophthalmol (Phila) 2020 Dec;9(6):549-556

Department of Ophthalmology, New Zealand National Eye Centre, Faculty of Medical and Health Sciences, The University of Auckland, Auckland, New Zealand.

Keratoconus is an ectatic disorder with highly complex and varied causes including genetic variations and environmental factors. Its prevalence varies widely between regions and countries. Many environmental factors have been proposed to be associated with keratoconus, but the interpretation of their individual contributions is difficult due to the presence of many confounding variables. Read More

Curr Eye Res 2021 May 13;46(5):763-764. Epub 2021 Apr 13.

Ophthalmology Department, Centro Hospitalar de Leiria, Leiria, Portugal.

Am J Ophthalmol Case Rep 2020 Dec 23;20:100938. Epub 2020 Sep 23.

Ophthalmic Unit, San Bassiano Hospital, Bassano Del Grappa, Italy.

Purpose: To report the clinical improvement observed in a glaucomatous patient affected by floppy eyelid syndrome and ectropion after treatment with Bimatoprost 0.03%.

Methods: Retrospective observational case report of a single glaucomatous patient (caucasian, 82 years old) affected by floppy eyelid syndrome with marked eyelid laxity and ectropion after 1 month of once a day 0. Read More

Curr Eye Res 2021 May 17;46(5):762. Epub 2020 Sep 17.

Department of Ophthalmology, University of Health Sciences, Ankara Diskapi Yildirim Beyazit Training and Research Hospital, Ankara, Turkey.

Cureus 2020 Aug 5;12(8):e9566. Epub 2020 Aug 5.

Ophthalmology, The Prince of Wales Hospital, Sydney, AUS.

Objective Our goal was to evaluate upper eyelid laxity by digital distraction, with the aim to determine sleeping laterality and the likelihood of obstructive sleep apnoea (OSA), and correlate these findings with polysomnography (PSG). Design We conducted a prospective, single-centre multidisciplinary study in a large sleep and respiratory department and an ophthalmology department within a tertiary referral university teaching hospital. Methods Patients with known OSA were evaluated using techniques based on the Lateralising Eyelid Sleep Compression (LESC) study. Read More

Ocul Surf 2020 10 24;18(4):706-712. Epub 2020 Jul 24.

Department of Ophthalmology, Loyola University Medical Center, USA. Electronic address:

Purpose: There is growing evidence for a critical role of the microbiome in ocular health and disease. We performed a prospective, observational study to characterize the ocular surface microbiome (OSM) in four chronic ocular surface diseases (OSDs) and healthy controls.

Methods: Sterile swabs were used to collect samples from each eye of 39 patients (78 eyes). Read More

Curr Eye Res 2021 01 16;46(1):31-34. Epub 2020 Jun 16.

Ophathmology Department, Centro Hospitalar De Leiria , Leiria, Portugal.

Purpose/aim: Floppy eyelid syndrome (FES) is an ocular manifestation of obstructive sleep apnea (OSA), but no studies have analyzed whether it can be improved by nocturnal continuous positive airway pressure (CPAP) therapy. The aim of this study was to analyze the effect of CPAP on FES by comparing objective measurements before and after 6 months of CPAP therapy.

Materials And Methods: We conducted a prospective study of 47 patients (74. Read More

Klin Monbl Augenheilkd 2020 Apr 24;237(4):534-536. Epub 2020 Apr 24.

Augenklinik, UniversitätsSpital Zürich, Schweiz.

Background: Globe luxation due to incarceration of the eyelids behind the globe can occur in patients with proptosis and lax eyelids. It is important to identify this rare event to prevent recurrent episodes with possible serious complications, such as optic neuropathy.

History And Signs: We present two patients (aged 54 and 83, both male) with recurrent painful globe luxation due to lid incarceration. Read More

Ophthalmic Plast Reconstr Surg 2020 Nov/Dec;36(6):562-565

Stein Eye Institute, University of California, Los Angeles, California, U.S.A.

Introduction: The floppy eyelid syndrome describes an eyelid disorder characterized by floppy tarsal plates that may be caused by a loss of elastin. The authors attempted to create floppy eyelids by digesting elastin from cadaveric tarsus and then treated them with cross-linking using ultraviolet A and riboflavin.

Methods: Nine right and 9 left upper eyelids were excised from cadavers. Read More

J Curr Ophthalmol 2019 Dec 29;31(4):450-453. Epub 2019 Mar 29.

Pathology Department, Farabi Eye Hospital, Tehran University of Medical Sciences, Tehran, Iran.

Purpose: To report a case of pachydermoperiostosis (PDP) and a review of the literature.

Methods: A 32-year-old man was referred to our clinic with bilateral eyelid swelling and blepharoptosis. On examination, marked blepharoptosis was noted, and his eyelids were found to be floppy. Read More

BMC Ophthalmol 2019 Dec 16;19(1):255. Epub 2019 Dec 16.

Department of Ophthalmology, Wilmer Eye Institute, Johns Hopkins Hospital, 600 North Wolfe Street, Baltimore, MD, 21287, USA.

Background: Floppy eyelid syndrome is a disorder in which the tarsal plate is easily distensible and is currently treated with conservative or surgical measures. Human tarsal plate contains type I collagen, which is crosslinked in corneal tissue as a treatment for keratoconus. We hypothesized that collagen crosslinking would similarly stiffen tarsal plate tissue and investigated this in porcine and human tarsal plate specimens. Read More

Strabismus 2020 03 12;28(1):42-48. Epub 2019 Dec 12.

Noor Ophthalmology Research Center, Noor Eye Hospital, Tehran.

: Determining the age and gender distribution of ocular disorders in Down syndrome patients aged 10 to 30 years.: In this study, 226 of 250 invited patients through special needs schools, the National Down Syndrome Society, and relevant nonprofit organizations were included. In Noor Eye Hospital, the patients underwent a complete eye examination by a general ophthalmologist and suspect cases were reexamined by a sub-specialist. Read More

Arch Soc Esp Oftalmol (Engl Ed) 2020 Jan 25;95(1):45-47. Epub 2019 Nov 25.

Departamento de Oftalmología, Hospital Universitari i Politecnic La Fe, Valencia, España.

A 55-year-old male presented with an infectious keratitis in his left eye, affecting one of the incisions of the radial keratotomy he had undergone thirty-four years ago. Suturing the incision with two simple interrupted stitches was key to the resolution of the infection. Floppy eyelid syndrome was also found in this patient. Read More

Plast Reconstr Surg Glob Open 2019 Oct 29;7(10):e2464. Epub 2019 Oct 29.

Hamilton Eye Institute, University of Tennessee Health Science Center, Memphis, Tenn.

The purpose of this article is to present a modified approach to the reconstruction of the upper and lower eyelids in floppy eyelid syndrome. A retrospective chart review was performed on all floppy eyelid patients who underwent simultaneous tightening of the upper and lower eyelid with a lateral tarsal strip, using a V-shaped incision in the lateral canthus, at University of Tennessee Hamilton Eye Institute from 2011 to 2012. Preoperative symptoms, surgical outcomes, complication rates, and postoperative symptoms were recorded. Read More

Ophthalmologe 2019 Nov;116(11):1091-1102

Klinik für Augenheilkunde und Poliklinik, Universitätsklinikum des Saarlandes, 66421, Homburg/Saar, Deutschland.

Clinically, the floppy eyelid syndrome is a frequent but underdiagnosed condition. This clinical phenotype is characterized by an extreme laxity of the eyelid, which is enlarged and has a rubber-like structure in combination with a pronounced hyperelastic tarsus. When looking down, minimal vertical tension can trigger spontaneous eversion of the upper eyelid leading to chronic papillary conjunctivitis. Read More

Ocul Surf 2020 01 5;18(1):31-39. Epub 2019 Oct 5.

Department of Ophthalmology, Long School of Medicine, University of Texas Health at San Antonio, San Antonio, TX, USA. Electronic address:

Floppy eyelid syndrome (FES) is defined as eyelid hyperlaxity with reactive palpebral conjunctivitis. It is a common condition that can be associated with significant ocular irritation. FES presents with easily everted eyelids and chronic papillary conjunctivitis in the upper eyelids. Read More

J Craniofac Surg 2019 Oct;30(7):2249-2250

Department of Ophthalmology, Meir Medical Center, Kfar Sava, Israel.

Introduction: Lash ptosis is often an overlooked sign that may coexist with congenital and acquired blepharoptosis. This is a report of case series of patients presented in an oculoplastic clinic with visual field loss associated with lash ptosis. On examination, the primary pathology was attributed to lash ptosis dehiscence. Read More

Curr Opin Ophthalmol 2019 Nov;30(6):513-524

Department of Ophthalmology, University of California San Francisco.

Purpose Of Review: 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.

Recent Findings: Virtually all patients with FES have obstructive sleep apnea (OSA). However, a significantly lower proportion of patients with OSA have FES. Read More

J Curr Ophthalmol 2019 Jun 8;31(2):225-228. Epub 2019 Apr 8.

Moorfields Eye Hospital, London, UK.

Purpose: To describe three individuals with severe keratitis and a substantial delay before floppy associated eyelid syndrome (FES) was identified, and to estimate the prevalence of severe corneal disease in individuals with FES.

Methods: We defined severe keratitis as corneal ulceration, vascularization or scar that affected vision. We recorded the clinical characteristics, the duration of symptoms before the diagnosis of FES, subsequent management and outcome. Read More

Rom J Ophthalmol 2019 Jan-Mar;63(1):2-9

"Marius Nasta Pneumophtisiology Institute, Bucharest, Romania; "Carol Davila" University of Medicine and Pharmacy, Bucharest, Romania.

The purpose of this paper is to review the association between a medical entity called the floppy eyelid syndrome (FES) and a very serious respiratory disease with repercussions on various other body organs and systems: the obstructive sleep apnea syndrome. The epidemiology, pathophysiology, and treatment of these two diseases are intertwined but still not enough recognized. Eye disorders affect a great number of patients in modern societies and the cause of their suffering is often left undiscovered, practitioners preferring a symptomatic treatment. Read More

Clin Exp Ophthalmol 2019 Sep 17;47(7):864-870. Epub 2019 Jun 17.

Ocular Plastics Unit, Department of Ophthalmology, Prince of Wales Hospital, Sydney, New South Wales, Australia.

Importance: Floppy eyelid syndrome "plasty" (FESplasty) is a surgical technique that addresses underlying superior tarsal plate and lateral canthal instability in floppy eyelid syndrome (FES) and aims to restore normal anatomical and physiological function to the upper eyelid.

Background: To describe the use of FESplasty in the surgical management of FES, and to report outcomes in an initial patient cohort.

Design: Retrospective study. Read More

J Fr Ophtalmol 2019 May 9;42(5):471-476. Epub 2019 Apr 9.

Department of ophthalmology, university hospital, 86000 Poitiers, France.

Purpose: To evaluate overall upper eyelid laxity according to age and sleep position.

Methods: This single-center prospective study was conducted on healthy subjects between 20 and 89 years of age and was approved by the institutional review board and the ethics committee. Data collected were age, sex, weight and height, ophthalmological history, general history (diabetes, hypertension, smoking) and preferred sleep position (lateral, ventral, dorsal decubitus or no preference). Read More

J Fr Ophtalmol 2019 Apr 15;42(4):e173-e175. Epub 2019 Mar 15.

Service d'Ophtalmologie, Hôpital Militaire d'Instruction Mohammed V, Faculté de médecine et de pharmacie, Université Mohammed V, Rabat, Maroc.

Ophthalmic Plast Reconstr Surg 2019 Mar/Apr;35(2):197-201

Department of Ophthalmology and Visual Sciences, Kellogg Eye Center, University of Michigan, Ann Arbor, Michigan, U.S.A.

Purpose: To evaluate the results of permanent medial tarsorrhaphy and to describe the surgical technique.

Methods: Medial tarsorrhaphy was performed on 30 eyelids with symptomatic exposure keratopathy secondary to eyelid malposition. Observational, retrospective review of preoperative and postoperative examination findings was performed. Read More