First described in 1981, floppy eye syndrome (FES) is characterized by very elastic upper lids that become easily distorted and everted with minimal lateral traction. In a case-control study, Ezra et al. have found that FES appears to be strongly associated with obstructive sleep apnea-hypopnea syndrome (OSAHS) and keratoconus. The study involved 102 FES patients and a control group of patients from a diabetic retinopathy clinic who were matched 1:1 in terms of age, body mass index (BMI), and sex. Not only did they find significant associations between FES and OSAHS and keratoconus, but between lash ptosis, dermatochalasis, upper lid medial canthal laxity, upper lid distraction, palpebral aperture, and levator function as well. In addition, while FES was more common in obese males in their 6th decade, the condition affected patients with a significant range of ages, BMI, and sex. The authors urge clinicians to keep in mind this strong association between FES, OSAHS, and keratoconus when determining the course of treatment.
