Floppy Eyelid Syndrome Clinical Presentation
- Author: Sean M Blaydon, MD, FACS; Chief Editor: Hampton Roy Sr, MD more...
History
- Presenting symptoms
- Unilateral or bilateral chronic eye irritation and burning
- Tearing
- Ropy, mucoid discharge; usually worse in the morning
- Decreased vision, if there is an associated keratopathy
- Daytime somnolence
- Morning headaches
- Sleep history
- Usually sleeps on side or face down in pillow
- Frequent episodes of waking up during the night
- Past ocular history
- Chalazia or hordeola
- Keratoconus
- Contact lens use
- Seasonal symptoms
- Past medical history
- Acne rosacea
- Psoriasis
- Hypertension
- Congestive heart failure
- Obstructive sleep apnea
Physical
- Complete ophthalmic examination
- External examination
- Lax upper eyelid that is everted easily when pulled superiorly toward eyebrow
- Soft and rubbery tarsal plate that can be folded upon itself
- Can quantify laxity by measurement of anterior eyelid distraction[14]
- Atrophic tarsal plate
- Stringy, mucoid conjunctival discharge
- Eyelash ptosis with loss of lash parallelism (ie, lashes lie in downward direction toward cornea and curve in different directions)[6]
- See the image below:
Eyelash ptosis in a patient with laxity of the upper eyelid. - Periorbital involutional changes
- Brow ptosis
- Eyelid dermatochalasis
- Blepharoptosis
- Attenuation or dehiscence of the lateral canthal tendon
- Lacrimal gland prolapse
- Involutional enophthalmos
- Lagophthalmos
- Slit lamp examination
- Lash debris (scurf)
- Superior papillary tarsal conjunctival hypertrophy
- Superior bulbar conjunctival injection
- Punctate fluorescein staining of superior cornea and conjunctiva
- Areas of devitalized epithelium and filamentary conjunctivitis with rose bengal stain
- Superficial corneal pannus at superior limbus
- Paracentral thinning of cornea consistent with keratoconus
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