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Floppy eyelid syndrome (FES) is an uncommon condition that it is often underdiagnosed or misdiagnosed owing to the somewhat trivial and non-specific symptoms with which it often presents.1, 2 In association with the dry eye of rheumatoid arthritis it can, however, have devastating effects.
A 60 year old moderately obese man with well controlled rheumatoid arthritis (RA) presented to the eye clinic with recurrent red and gritty eyes. A diagnosis of dry eye syndrome with blepharitis was made. He was also found to have a mucocoele of the left lacrimal sac. Lid hygiene and ocular lubricants yielded an initial encouraging response and he was discharged.
He re-presented 5 years later with similar symptoms and reduced visual acuity (VA) of 6/36 in the left eye. A diagnosis of dry eye syndrome with secondary corneal epithelial changes was made. Topical lubricants failed to relieve the condition satisfactorily and he was therefore scheduled for punctal occlusion. However, upon admission for this 8 weeks later, he was …