Floppy Eyelid Syndrome Surgery New Jersey and New York
Floppy eyelid syndrome is a common but significantly under diagnosed condition. It is estimated that as many as 15 or 16% of people can be affected by this condition. Originally, floppy eyelids syndrome have been associated with overweight or obese men between 45 and 55 years old, however, later studies show that floppy eyelid syndrome can also happen in population of all ages, including children.
Floppy eyelid syndrome is a condition associated with chronic redness of the eye, irritation, chronic foreign body sensation, discharge or drainage in the morning that gets better later on throughout the day, ectropion, and other non-specific symptoms.
Pathophysiology of floppy eyelid syndrome
The main problem with floppy eyelid syndrome patients is that they have laxity or loosening of the upper eyelid. As a result of the over-stretchable upper eyelid, the patient can experience exposure of the cornea at night while they are asleep. As a result they may develop chronic inflammation and irritation of the eyes, including drainage, and all other symptoms. Because condition is not commonly recognized, many patients suffer from this condition for years before getting proper treatment.
Floppy eyelid syndrome and other conditions
There is also association of floppy eyelid syndrome with obstructive sleep apnea. There’s also association of floppy eyelid syndrome with condition known as keratoconus.
The pathophysiology of floppy eyelid syndrome is not clear. There are several possible reasons why patients may be suffering from floppy eyelid syndrome.
Many studies showed decreased level of elastic fibers within the tarsal plate and eyelid skin in the patients with floppy eyelid syndrome. Scientists believe that this is a result of overactivity of the enzymes responsible for dissolving the elastin fibers. But on the other hand, patients with floppy eyelid syndrome have increased amount of another elastin variant, OXYTALAN.
The mechanical theory of floppy eyelid syndrome suggests that the upper eyelids are very easily flipped over or everted, allowing exposure and irritation of the conjunctiva and outer surface of the eye. That eventually leads to chronic inflammation. Interesting is that keratoconus is also associated with the same type of trauma. Usually the patients are more prone to the exposure when they’re sleeping on the side or face down. Some studies show that floppy eyelid syndrome affects more the side on which the patient usually sleeps on.
The next theory is a theory of local ischemia and reperfusion. It is thought that the patients develop intermittent ischemia as a result of obstructive sleep apnea. When the patient wakes up, the reperfusion, or improvement of the blood supply, occurs, and the patient is subjected to the damage associated with acute oxidative stress. It is a bit confusing, but the idea is that intermittent loss and return of the blood supply eventually results in loosening of the tissues.
Diagnosis of floppy eyelid syndrome
Diagnosis of floppy eyelid syndrome is usually performed based on clinical exam. Patients are usually demonstrating evidence of chronic irritation, with loosening or weakness of the upper eyelid with upward pulling or traction and associated conjunctivitis. Greater degree of suspicion is for patients with keratoconus or with obstructive sleep apnea.
Treatment of floppy eyelid syndrome
Management of the floppy eyelid syndrome is divided into parts.
Medical management or conservative management of floppy eyelid syndrome is focused on maintaining proper eyelid position, especially at night and preventing corneal exposure. The treatments include local ointments, shields, special humidity goggles, or taping of the eyelid. Unfortunately, all these methods are not very effective in patients with obstructive sleep apnea. Usually the symptoms are improved when patients start using CPAP machine and especially with weight loss.
Surgical treatment is a very effective. It involves tightening of the upper eyelids or upper and lower eyelids using a variety of different techniques. It is usually performed after failure of conservative methods. Procedure is performed under local anesthesia or sedation on the outpatient basis.
Dr Volshteyn approach to management of floppy eyelid syndrome
Dr. Volshteyn performs at least three separate procedures for floppy eyelid syndrome depending on extend of the condition severity, patient age and desired outcome. Many of his patients also have cosmetic blepharoplasty or eyelid tuck at the same time.
If you have been diagnosed with floppy eyelid syndrome, and you’re not able to get out a good improvement by using conservative measures, please call our office.
Please note that we do not perform medical management of the floppy eyelid syndrome and you will have to have a referral from a qualified ophthalmologist who would confirm that you require surgery and medical management has failed.
To schedule your appointment with Dr. Volshteyn call 732-641-3350.
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