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| CASE REPORT |
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| Year : 2020 | Volume
: 2
| Issue : 1 | Page : 1 |
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A floppy eyelid syndrome case report: Surgery and histopathologic features
Marcela Feltrin de Barros, Livia Garcia Biselli, Gustavo Kalache, Marcelo Vicente de Andrade Sobrinho, Laryssa Pereira Alves, Daniella De Paiva Almeida Stucchi
Department of Ophthalmology, Pontifícia Universidade de Campinas, Campinas, São Paulo, Brazil
| Date of Submission | 07-Nov-2019 |
| Date of Decision | 23-Dec-2019 |
| Date of Acceptance | 09-Dec-2019 |
| Date of Web Publication | 23-Jan-2020 |
Correspondence Address:
Dr. Marcela Feltrin de Barros
Rua Itabirito 965, Jardim Ipiranga, CEP: 13468520, Americana, São Paulo
Brazil
 Source of Support: None, Conflict of Interest: None
DOI: 10.4103/PAJO.PAJO_22_19
We report a case of floppy eyelid syndrome (FES) treated with surgical approach at the PUC Campinas Hospital in 2019. This was a retrospective case report. A 42-year-old male patient diagnosed with FES. The patient elected for surgical repair due to severity of his symptoms. A lateral pentagonal upper eyelid resection was performed in the left eye, and eyelid tissue from the patient was examined using light microscopy and immunohistochemistry that revealed chronic conjunctival inflammation and papillary conjunctivitis. The pentagonal wedge resection is an effective treatment method that produces immediate relief of symptoms. In our case, no recurrence was observed up to 6-month follow-up.
Keywords: Eyelid, floppy eye, inflammation, surgery, tarsus
How to cite this article:
de Barros MF, Biselli LG, Kalache G, de Andrade Sobrinho MV, Alves LP, Almeida Stucchi DD. A floppy eyelid syndrome case report: Surgery and histopathologic features. Pan Am J Ophthalmol 2020;2:1 |
How to cite this URL:
de Barros MF, Biselli LG, Kalache G, de Andrade Sobrinho MV, Alves LP, Almeida Stucchi DD. A floppy eyelid syndrome case report: Surgery and histopathologic features. Pan Am J Ophthalmol [serial online] 2020 [cited 2023 May 28];2:1. Available from: https://www.thepajo.org/text.asp?2020/2/1/1/276596 |
| Introduction | |  |
Floppy eyelid syndrome (FES) is characterized by a loose upper lid that is easily everted by pulling it upward, a foldable tarsus and chronic papillary conjunctivitis.[1]
Histological studies of the tarsus demonstrated a decrease of elastin fibers, and others suggest chronic inflammatory infiltrate.[2]
This syndrome is often underdiagnosed due to unspecific complaints, such as ocular irritation, redness, mucoid discharge, and light sensitivity.[3],[4] FES may be associated with several systemic conditions, most commonly obesity, hypertension, obstructive sleep apnea, and corneal abnormalities.[5],[6]
Effective treatments include clinical management and surgical approach.
We reported a case of FES treated with surgical approach at PUC Campinas Hospital.
| Case Report | | |
A 42-year-old male patient presented with an 8-week history of left eye irritation and discharge. He was brought to the clinic by his spouse after she noticed eversion of his left eyelid during sleeping. His medical history revealed hypertension, diabetes, and obstructive sleep apnea. At the ocular examination, the patient presented visual acuity 20/20 right eye and 20/30 left eye; biomicroscopy revealed superficial punctate keratitis; and the external examination showed a significant eversion of the left upper eyelid with minimal upward traction [Figure 1].
Ocular management was initially conservative with lubricating ointment and included taping the eyelid shut at night. He was referred to otorhinolaryngologic and clinical evaluation.
The patient returned for his follow-up with no improvement of ocular irritation and discharge. Due to severity of his symptoms, the patient was elected for surgical repair. A lateral pentagonal upper eyelid resection was performed in the left eye [Figure 2] and [Figure 3], and eyelid tissue from the patient was examined using light microscopy and immunohistochemistry [Figure 4] and [Figure 5] that revealed chronic conjunctival inflammation and papillary conjunctivitis. Seven days after the surgery, the patient presented immediate relief of his symptoms [Figure 6]. After 6 months of follow-up, the patient presented complete improvement of his symptoms and was very pleased with the surgical outcome with significant enhancement of quality of life. | Figure 4: Immunohistochemistry demonstrates cell proliferation just in the basal cell layer, excluding malignancy
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 | Figure 5: Inflammatory process with moderate activity and areas with reactive hyperplasia of adjacent epithelium
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| Discussion | | |
The pathophysiology of FES and the symptoms of the disease are primarily thought to be caused by mechanical irritation and chronic mechanical injury. These mechanical forces may lead to abnormalities in elastin and chronic conjunctival inflammation.[7]
Conservative management may be used initially; the clinical treatment involves losing weight, taping the eyelids during the night, and topical lubricants.[8] Surgical intervention is the main and more effective treatment for FES. Published techniques for surgical tightening include lateral tarsorrhaphy, lateral tarsal strip, and a pentagonal wedge resection.[9],[10]
In our case, the laxity in the upper eyelids was corrected by pentagonal wedge resection in the upper eyelid, promoting an immediate relief of symptoms and no recurrence after 6-month of follow-up.
Declaration of patient consent
The authors certify that they have obtained all appropriate patient consent forms. In the form the patient(s) has/have given his/her/their consent for his/her/their images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed.
Financial support and sponsorship
Nil.
Conflicts of interest
There are no conflicts of interest.
| References | | |
| 1. | Brown MD, Potter JW. Floppy eyelid syndrome: A case report and clinical review. J Am Optom Assoc 1992;63:309-14.  |
| 2. | Netland PA, Sugrue SP, Albert DM, Shore JW. Histopathologic features of the floppy eyelid syndrome. Involvement of tarsal elastin. Ophthalmology 1994;101:174-81. |
| 3. | Holbach LM. Diseases of the eyelid-conjunctival complex and corneal complications of lid disease. Curr Opin Ophthalmol 1995;6:39-43. |
| 4. | Culbertson WW, Ostler HB. The floppy eyelid syndrome. Am J Ophthalmol 1981;92:568-75. |
| 5. | Langford JD, Linberg JV. A new physical finding in floppy eyelid syndrome. Ophthalmology 1998;105:165-9. |
| 6. | Karger RA, White WA, Park WC, Rosales AG, McLaren JW, Olson EJ, et al. Prevalence of floppy eyelid syndrome in obstructive sleep apnea-hypopnea syndrome. Ophthalmology 2006;113:1669-74. |
| 7. | Pihlblad MS, Schaefer DP. Eyelid laxity, obesity, and obstructive sleep apnea in keratoconus. Cornea 2013;32:1232-6. |
| 8. | McNab AA. Reversal of floppy eyelid syndrome with treatment of obstructive sleep apnoea. Clin Exp Ophthalmol 2000;28:125-6. |
| 9. | Burkat CN, Lemke BN. Acquired lax eyelid syndrome: An unrecognized cause of the chronically irritated eye. Ophthalmic Plast Reconstr Surg 2005;21:52-8. |
| 10. | Dutton JJ. Surgical management of floppy eyelid syndrome. Am J Ophthalmol 1985;99:557-60. |
[Figure 1], [Figure 2], [Figure 3], [Figure 4], [Figure 5], [Figure 6]
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