eMedicine Specialties > Ophthalmology > Lid

Floppy Eyelid Syndrome: Follow-up

Author: Sean M Blaydon, MD, FACS, Texas Oculoplastic Consultants, Austin, Texas
Contributor Information and Disclosures

Updated: Dec 18, 2008

Follow-up

Further Inpatient Care

  • Floppy eyelid syndrome is usually treated on an outpatient basis.

Further Outpatient Care

  • Patient should be observed every 3-7 days initially until any keratitis is resolved; then, the patient can be observed every 2-6 weeks, as necessary.

Inpatient & Outpatient Medications

  • Antibiotic ophthalmic ointment, such as erythromycin, is prescribed postoperatively 2-4 times a day along sutures and in the eye for 1 week. See Medication.
  • Lubricating ophthalmic ointment in the eye at bedtime can be continued, as needed.

Deterrence/Prevention

  • Patients with floppy eyelid syndrome should be encouraged to refrain from sleeping with their face in the pillow, to avoid rubbing their eyes, and to lose weight if obese.
  • Special shields or a mask may need to be fitted to shield the eye from this mechanical irritation.

Complications

  • Complications of surgery to repair floppy eyelid syndrome include the following:
    • Poor wound healing
    • Unacceptable eyelid height or contour

Prognosis

  • A medical and surgical approach to managing floppy eyelid syndrome is most often successful in improving the patient's symptoms.

Patient Education

  • The following items should be discussed with the patient:
    • Significance of sleeping with the face against the pillow
    • Connection between rubbing eyes, keratoconus, and floppy eyelid syndrome
    • Possibility of associated obstructive sleep apnea and, if warranted, the need for further tests to evaluate for this condition
    • Treatment options

Miscellaneous

Medicolegal Pitfalls

  • Patient should be evaluated for obstructive sleep apnea because this can be a fatal condition.
 


More on Floppy Eyelid Syndrome

Overview: Floppy Eyelid Syndrome
Differential Diagnoses & Workup: Floppy Eyelid Syndrome
Treatment & Medication: Floppy Eyelid Syndrome
Follow-up: Floppy Eyelid Syndrome
Multimedia: Floppy Eyelid Syndrome
References
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References

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  3. McNab AA. The eye and sleep. Clin Experiment Ophthalmol. Apr 2005;33(2):117-25. [Medline].

  4. Karger RA, White WA, Park W, et al. Prevalence of floppy eyelid syndrome in obstructive sleep apnea-hypopnea syndrome. Ophthalmology. Sep 2006;113(9):1669-74. [Medline].

  5. Netland PA, Sugrue SP, Albert DM, et al. Histopathologic features of the floppy eyelid syndrome. Involvement of tarsal elastin. Ophthalmology. Jan 1994;101(1):174-81. [Medline].

  6. Schlotzer-Schrehardt U, Stojkovic M, Hofmann-Rummelt C, et al. The pathogenesis of floppy eyelid syndrome: involvement of matrix metalloproteinases in elastic fiber degradation. Ophthalmology. Apr 2005;112(4):694-704. [Medline].

  7. Donnenfeld ED, Perry HD, Gibralter RP, et al. Keratoconus associated with floppy eyelid syndrome. Ophthalmology. Nov 1991;98(11):1674-8. [Medline].

  8. Goldberg R, Seiff S, McFarland J, et al. Floppy eyelid syndrome and blepharochalasis. Am J Ophthalmol. Sep 15 1986;102(3):376-81. [Medline].

  9. Gonnering RS, Sonneland PR. Meibomian gland dysfunction in floppy eyelid syndrome. Ophthal Plast Reconstr Surg. 1987;3(2):99-103. [Medline].

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  12. Iyengar SS, Khan JA. Quantifying upper eyelid laxity in symptomatic floppy eyelid syndrome by measurement of anterior eyelid distraction. Ophthal Plast Reconstr Surg. May-Jun 2007;23(3):255. [Medline].

  13. Schwartz LK, Gelender H, Forster RK. Chronic conjunctivitis associated with 'floppy eyelids'. Arch Ophthalmol. Dec 1983;101(12):1884-8. [Medline].

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  15. Dutton JJ. Surgical management of floppy eyelid syndrome. Am J Ophthalmol. May 15 1985;99(5):557-60. [Medline].

  16. Moore MB, Harrington J, McCulley JP. Floppy eyelid syndrome. Management including surgery. Ophthalmology. Feb 1986;93(2):184-8. [Medline].

  17. Periman LM, Sires BS. Floppy eyelid syndrome: a modified surgical technique. Ophthal Plast Reconstr Surg. Sep 202;(18)5:370-2. [Medline].

  18. Valenzuela AA, Sullivan TJ. Medial upper eyelid shortening to correct medial eyelid laxity in floppy eyelid syndrome: a new surgical approach. Ophthal Plast Reconstr Surg. Jul 2005;21(4):259-63. [Medline].

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Further Reading

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Keywords

floppy eyelid syndrome, FES, lax eyelid syndrome, obstructive sleep apnea, OSA

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Contributor Information and Disclosures

Author

Sean M Blaydon, MD, FACS, Texas Oculoplastic Consultants, Austin, Texas
Sean M Blaydon, MD, FACS is a member of the following medical societies: American Academy of Ophthalmology, American College of Surgeons, American Medical Association, American Society of Ophthalmic Plastic and Reconstructive Surgery, Association of Military Surgeons of the US, International College of Surgeons US Section, Pan-American Association of Ophthalmology, Pan-Pacific Surgical Association, and Texas Medical Association
Disclosure: Nothing to disclose.

Medical Editor

Jorge G Camara, MD, Professor of Ophthalmology, Department of Surgery and Director of Fellowship Training Program in Ophthalmic Plastic and Reconstructive Surgery for Countries Served by the Aloha Medical Mission, University of Hawaii John A Burns School of Medicine
Jorge G Camara, MD is a member of the following medical societies: American Academy of Ophthalmology, American Medical Association, and American Society of Ophthalmic Plastic and Reconstructive Surgery
Disclosure: Nothing to disclose.

Pharmacy Editor

Francisco Talavera, PharmD, PhD, Senior Pharmacy Editor, eMedicine
Disclosure: eMedicine Salary Employment

Managing Editor

Mark T Duffy, MD, PhD, Consulting Staff, Division of Oculoplastic, Orbito-facial, Lacrimal and Reconstructive Surgery, Green Bay Eye Clinic, BayCare Clinic; Medical Director, Advanced Cosmetic Solutions, A BayCare Clinic
Mark T Duffy, MD, PhD is a member of the following medical societies: American Academy of Ophthalmology, American Medical Association, American Society of Ophthalmic Plastic and Reconstructive Surgery, Sigma Xi, and Society for Neuroscience
Disclosure: Allergan - Botox Cosmetic Consulting fee Consulting; Quest medical - lacrimal balloons Honoraria Speaking and teaching; Ortho-Neutrogenia Consulting fee Consulting

CME Editor

Lance L Brown, OD, MD, Ophthalmologist, Affiliated With Freeman Hospital and St John's Hospital, Regional Eye Center, Joplin, Missouri
Disclosure: Nothing to disclose.

Chief Editor

Hampton Roy Sr, MD, Associate Clinical Professor, Department of Ophthalmology, University of Arkansas for Medical Sciences
Hampton Roy Sr, MD is a member of the following medical societies: American Academy of Ophthalmology, American College of Surgeons, and Pan-American Association of Ophthalmology
Disclosure: Nothing to disclose.

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