Sleep Medicine xxx (2014) xxx–xxx
Contents lists available at ScienceDirect
Sleep Medicine journal homepage: www.elsevier.com/locate/sleep
Floppy eyelid syndrome in obstructive sleep apnea syndrome Valentín Huerva a,b,⇑, M. Jesús Muniesa a,b, Francisco J. Ascaso c,d a
Department of Ophthalmology, Universitary Hospital Arnau de Vilanova, Lleida, Spain IRB-Lleida, Lleida, Spain c Department of Ophthalmology, ‘Lozano Blesa’ University Clinic Hospital, Zaragoza, Spain d Aragon Health Sciences Institute, Zaragoza, Spain b
a r t i c l e
i n f o
Article history: Received 1 September 2013 Received in revised form 14 December 2013 Accepted 19 December 2013 Available online xxxx Keywords: Floppy eyelid Sleep apnea Chronic conjunctivitis Lax eyelid Tearing Eye redness
1. Introduction A 62-year-old man presented with complaints of foreign body sensation, burning, tearing and redness in both eyes. An easy eversion of the upper eyelids was accomplished with minimal manipulation (Fig. 1A). Another 70-year-old man presented with similar symptoms. A spontaneous eversion of the right upper eyelid was observed when he closed his eyes (Fig. 1B). Both patients were previously diagnosed with obstructive sleep apnea syndrome (OSAS).
lead to ocular surface and tear film disorders and therefore a chronic conjunctivitis with the above-mentioned symptomatology. 3. Discussion FES is an often forgotten and underdiagnosed entity characterized by flaccid and easily everted upper lids, occurring spontaneously or with minimal manipulation. It is usually seen in overweight, middleaged males who complain of a foreign body sensation, burning, tearing and redness. Some studies have found an interesting association with OSAS [1,2]. This relationship may have both diagnostic and therapeutic implications. Nevertheless, the majority of OSAS patients, obese or non-obese, do not have FES. Furthermore, FES may also be a presenting symptom in patients with undiagnosed OSAS [2]. Although the cause remains unknown, in all probability OSAS has no real causative relationship, other than a sequence of extreme apnea, right heart failure, and increased venous pressure that worsens a propensity for this phenomenon. Additionally, treatment of obesity and OSAS may have a favourable effect on the course of FES [3]. The clinician should be aware of this association so that both underlying OSAS or FES can be detected.
2. Image analysis Both cases correspond with floppy eyelid syndrome (FES). Diagnosis of FES is straightforward. The two basic maneuvers include: complete eversion of the upper eyelids while applying slight traction, and spontaneous eversion of the upper eyelids while closing the eyes. The hyperlaxity and the nocturnal eyelid eversion may
⇑ Corresponding author at: Department of Ophthalmology, Universitary Hospital Arnau de Vilanova, Avda. Alcade Rovira Roure 80, 25198 Lleida, Spain. Tel.: +34 973 705306; fax: +34 973 248754. E-mail address: [email protected] (V. Huerva).
Fig. 1. Easy diagnosis of floppy eyelid syndrome with few simple maneuvers. (A) Complete eversion of lids with simple traction. (B) Spontaneous eversion of the right upper eyelid while closing the eyes.
http://dx.doi.org/10.1016/j.sleep.2013.12.017 1389-9457/Ó 2014 Elsevier B.V. All rights reserved.
Please cite this article in press as: Huerva V et al. Floppy eyelid syndrome in obstructive sleep apnea syndrome. Sleep Med (2014), http://dx.doi.org/ 10.1016/j.sleep.2013.12.017
2
V. Huerva et al. / Sleep Medicine xxx (2014) xxx–xxx
The condition should be suspected in any obese patient with chronic watery and red eyes. Besides weight loss and continuous positive airway pressure therapy if OSAS is suspected, treatment consists of supportive measures such as ocular lubrication, eyelid taping, or an eyeshield at bedtime to keep the eyelids closed while sleeping, and surgery to address horizontal laxity and redundant eyelid tissues.
The ICMJE Uniform Disclosure Form for Potential Conflicts of Interest associated with this article can be viewed by clicking on the following link: http://dx.doi.org/10.1016/j.sleep.2013.12.017.
Funding sources
[1] Abdal H, Pizzimenti JJ, Purvis CC. The eye in sleep apnea syndrome. Sleep Med 2006;7:107–15. [2] Leibovitch I, Selva D. Floppy eyelid syndrome: clinical features and the association with obstructive sleep apnea. Sleep Med 2006;7:117–22. [3] McNab AA. Reversal of floppy eyelid syndrome with treatment of obstructive sleep apnea. Clin Exp Ophthalmol 2000;28:125–6.
None.
Conflict of interest
References
Please cite this article in press as: Huerva V et al. Floppy eyelid syndrome in obstructive sleep apnea syndrome. Sleep Med (2014), http://dx.doi.org/ 10.1016/j.sleep.2013.12.017
Contents lists available at ScienceDirect
Sleep Medicine journal homepage: www.elsevier.com/locate/sleep
Floppy eyelid syndrome in obstructive sleep apnea syndrome Valentín Huerva a,b,⇑, M. Jesús Muniesa a,b, Francisco J. Ascaso c,d a
Department of Ophthalmology, Universitary Hospital Arnau de Vilanova, Lleida, Spain IRB-Lleida, Lleida, Spain c Department of Ophthalmology, ‘Lozano Blesa’ University Clinic Hospital, Zaragoza, Spain d Aragon Health Sciences Institute, Zaragoza, Spain b
a r t i c l e
i n f o
Article history: Received 1 September 2013 Received in revised form 14 December 2013 Accepted 19 December 2013 Available online xxxx Keywords: Floppy eyelid Sleep apnea Chronic conjunctivitis Lax eyelid Tearing Eye redness
1. Introduction A 62-year-old man presented with complaints of foreign body sensation, burning, tearing and redness in both eyes. An easy eversion of the upper eyelids was accomplished with minimal manipulation (Fig. 1A). Another 70-year-old man presented with similar symptoms. A spontaneous eversion of the right upper eyelid was observed when he closed his eyes (Fig. 1B). Both patients were previously diagnosed with obstructive sleep apnea syndrome (OSAS).
lead to ocular surface and tear film disorders and therefore a chronic conjunctivitis with the above-mentioned symptomatology. 3. Discussion FES is an often forgotten and underdiagnosed entity characterized by flaccid and easily everted upper lids, occurring spontaneously or with minimal manipulation. It is usually seen in overweight, middleaged males who complain of a foreign body sensation, burning, tearing and redness. Some studies have found an interesting association with OSAS [1,2]. This relationship may have both diagnostic and therapeutic implications. Nevertheless, the majority of OSAS patients, obese or non-obese, do not have FES. Furthermore, FES may also be a presenting symptom in patients with undiagnosed OSAS [2]. Although the cause remains unknown, in all probability OSAS has no real causative relationship, other than a sequence of extreme apnea, right heart failure, and increased venous pressure that worsens a propensity for this phenomenon. Additionally, treatment of obesity and OSAS may have a favourable effect on the course of FES [3]. The clinician should be aware of this association so that both underlying OSAS or FES can be detected.
2. Image analysis Both cases correspond with floppy eyelid syndrome (FES). Diagnosis of FES is straightforward. The two basic maneuvers include: complete eversion of the upper eyelids while applying slight traction, and spontaneous eversion of the upper eyelids while closing the eyes. The hyperlaxity and the nocturnal eyelid eversion may
⇑ Corresponding author at: Department of Ophthalmology, Universitary Hospital Arnau de Vilanova, Avda. Alcade Rovira Roure 80, 25198 Lleida, Spain. Tel.: +34 973 705306; fax: +34 973 248754. E-mail address: [email protected] (V. Huerva).
Fig. 1. Easy diagnosis of floppy eyelid syndrome with few simple maneuvers. (A) Complete eversion of lids with simple traction. (B) Spontaneous eversion of the right upper eyelid while closing the eyes.
http://dx.doi.org/10.1016/j.sleep.2013.12.017 1389-9457/Ó 2014 Elsevier B.V. All rights reserved.
Please cite this article in press as: Huerva V et al. Floppy eyelid syndrome in obstructive sleep apnea syndrome. Sleep Med (2014), http://dx.doi.org/ 10.1016/j.sleep.2013.12.017
2
V. Huerva et al. / Sleep Medicine xxx (2014) xxx–xxx
The condition should be suspected in any obese patient with chronic watery and red eyes. Besides weight loss and continuous positive airway pressure therapy if OSAS is suspected, treatment consists of supportive measures such as ocular lubrication, eyelid taping, or an eyeshield at bedtime to keep the eyelids closed while sleeping, and surgery to address horizontal laxity and redundant eyelid tissues.
The ICMJE Uniform Disclosure Form for Potential Conflicts of Interest associated with this article can be viewed by clicking on the following link: http://dx.doi.org/10.1016/j.sleep.2013.12.017.
Funding sources
[1] Abdal H, Pizzimenti JJ, Purvis CC. The eye in sleep apnea syndrome. Sleep Med 2006;7:107–15. [2] Leibovitch I, Selva D. Floppy eyelid syndrome: clinical features and the association with obstructive sleep apnea. Sleep Med 2006;7:117–22. [3] McNab AA. Reversal of floppy eyelid syndrome with treatment of obstructive sleep apnea. Clin Exp Ophthalmol 2000;28:125–6.
None.
Conflict of interest
References
Please cite this article in press as: Huerva V et al. Floppy eyelid syndrome in obstructive sleep apnea syndrome. Sleep Med (2014), http://dx.doi.org/ 10.1016/j.sleep.2013.12.017
