Floppy eyelid syndrome (FES) has a strong association with obstructive sleep apnea. The mechanism of upper eyelid eversion during sleep causing ocular surface disease involves:

• A Elastin fiber loss in the tarsus causing superior tarsus to become flaccid and evert against the pillow during sleep ✓
• B Tarsal plate cartilage degeneration from chronic UV exposure causing mechanical laxity
• C Superior rectus muscle laxity causing upper lid lag on downgaze
• D Orbicularis oculi muscle atrophy from neuropathy associated with OSA

Explanation

Floppy eyelid syndrome results from histopathological loss of elastin fibers in the upper tarsal plate, making the superior tarsus abnormally lax and rubbery. During sleep, the upper lid easily everts against the pillow or bedding, exposing the superior palpebral conjunctiva (leading to papillary conjunctivitis) and cornea to friction and desiccation. The ocular surface damage causes chronic papillary conjunctivitis, punctate keratopathy, and mucous discharge. Management includes treating OSA (CPAP reduces lid laxity over time) and lid taping or shields during sleep.

Reference: Khurana Comprehensive Ophthalmology, 7th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.