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Nat Sci Sleep 2022 23;14:277-290. Epub 2022 Feb 23.

Biostatistics Center, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung City, Taiwan.

Purpose: Obstructive sleep apnea/hypopnea syndrome (OSA) results in repeated oxygen desaturation, repeated arousals, and episodic nocturnal activation of sympathetic nervous system during sleep. Untreated OSA is strongly associated with an increase of cardio- and cerebrovascular disorders, as well as the damages of ophthalmological microstructures. However, previous literature only simply studied the association between the ophthalmic disorders and OSA. Read More

Clin Exp Ophthalmol 2022 04 16;50(3):334-344. Epub 2022 Mar 16.

Centre for Ophthalmology and Visual Science (incorporating the Lions Eye Institute), University of Western Australia, Perth, Western Australia, Australia.

There is a growing body of literature on the effects of sleep disorders, in particular obstructive sleep apnoea (OSA), on ocular health, with consistent evidence of an increased risk of floppy eyelid syndrome, non-arteritic anterior ischaemic optic neuropathy, diabetic macular oedema, and other retinal vasculature changes in individuals with OSA. However, reports on OSA's associations with glaucoma, papilloedema, diabetic retinopathy, central serous chorioretinopathy, and keratoconus have been conflicting, while links between OSA and age-related macular degeneration have only been described fairly recently. Despite numerous suggestions that OSA treatment may reduce risk of these eye diseases, well-designed studies to support these claims are lacking. Read More

Front Med (Lausanne) 2022 9;9:832954. Epub 2022 Feb 9.

Department of Ophthalmology, The Second Xiangya Hospital of Central South University, Changsha, China.

Purpose: To assess the ocular surface and meibomian gland (MG) of patients with obstructive sleep apnea hypopnea syndrome (OSAHS) and to explore the effects of surgery for OSAHS on the ocular surface and MG.

Methods: Based on the apnea hypopnea index (AHI), 21 patients with mild OSAHS (Group A, 5/h ≤ AHI < 15/h), 20 patients with moderate OSAHS (Group B, 15/h ≤ AHI < 30/h), 62 patients with severe OSAHS (Group C, AHI ≥ 30/h) were examined. The ocular surface and MG were evaluated using Keratograph 5M. Read More

Ther Adv Ophthalmol 2021 Jan-Dec;13:25158414211059247. Epub 2021 Dec 5.

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

Floppy eyelid syndrome (FES) is a frequent eyelid disorder characterized by eyelid laxity that determines a spontaneous eyelid eversion during sleep associated with chronic papillary conjunctivitis and systemic diseases. FES is an under-diagnosed syndrome for the inaccuracy of definition and the lack of diagnostic criteria. Eyelid laxity can result from a number of involutional, local, and systemic diseases. Read More

Obes Surg 2022 04 29;32(4):1103-1109. Epub 2022 Jan 29.

Department of Anesthesiology, University of Nebraska Medical Center, 42nd and Emile, Omaha, NE, 68198, USA.

Purpose: Obstructive sleep apnea (OSA) presents perioperative challenges with increased risk for complications. Floppy eyelid syndrome (FES) is associated with OSA yet has not been addressed perioperatively. The current standard for perioperative OSA screening includes assessing patient risk factors or the STOP-BANG tool, which requires an active participant. Read More

J Fr Ophtalmol 2022 Feb 24;45(2):191-200. Epub 2021 Dec 24.

Department of Neurology, University of Health Sciences, Yuksek Ihtisas Training and Research Hospital, Bursa, Turkey.

Purpose: To evaluate the ocular surface, eyelid changes, meibomian gland morphology, corneal endothelial morphology, and corneal topographic measurements in patients with obstructive sleep apnea syndrome (OSAS).

Methods: There were 47 patients diagnosed with OSAS and 47 healthy volunteers included in the study. Non-invasive tear break-up time (NITBUT), corneal topography, meibography, and specular microscopy were performed. Read More

Int J Emerg Med 2021 Dec 18;14(1):74. Epub 2021 Dec 18.

Department of Emergency Medicine, Kirk Kerkorian School of Medicine at UNLV, 901 Rancho Lane, Ste 135, Las Vegas, NV, 89106, USA.

Background: Spontaneous globe subluxation (SGS) is an atraumatic anterior dislocation of the eyeball. It is exceedingly rare. Understanding SGS predisposing factors may help uncover its etiology and undertake vision-saving management. Read More

Int Ophthalmol 2022 Mar 18;42(3):933-938. Epub 2021 Oct 18.

Department of Ophthalmology, Gulhane Education and Research Hospital, Ankara, Turkey.

Purpose: This study aimed to compare the tomographic features of the cornea on elevation maps between obstructive sleep apnea syndrome (OSAS) and keratoconus (KC) patients and to investigate the presence of susceptibility to ectatic corneal diseases in OSAS patients.

Design: This is a comparative cross-sectional case-control study.

Methods: This study included 84 eyes of 42 patients diagnosed with severe OSAS using polysomnography (apnea/hypopnea index > 30), 84 eyes of 56 patients diagnosed with keratoconus, and 84 eyes of 42 healthy subjects as control group and evaluated in three groups. Read More

Graefes Arch Clin Exp Ophthalmol 2022 Mar 15;260(3):893-900. Epub 2021 Oct 15.

Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.

Purpose: To examine the efficacy of preoperative administration of topical atropine 1% and non-steroidal anti-inflammatory drugs (NSAIDs) for prevention of intraoperative floppy iris syndrome (IFIS).

Methods: In this retrospective cohort study, patients who underwent cataract surgery by phacoemulsification between July 2019 and February 2020 in two hospitals were included. Both hospitals are located in central Israel, have similar patient demographics and employ similar surgical techniques. Read More

Ophthalmic Plast Reconstr Surg 2022 Mar-Apr 01;38(2):e36-e38

Department of Ophthalmology, New York University, New York, New York, U.S.A.

A newborn male with cat eye syndrome presented with progressively worsening bilateral upper eyelid imbrication, floppy eyelids, and ptosis. Despite conservative management, he remained unable to open his eyelids. Surgical correction was planned to prevent bilateral sensory deprivation amblyopia and was delayed until 5 months of age due to systemic health concerns. Read More

Transl Vis Sci Technol 2021 04;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 06 6;25(3):193-195. Epub 2021 May 6.

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 Sep 4;60(9):e368-e370. 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 05 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 05 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