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Floppy eyelid syndrome (FES) encompasses a group of disorders involving easily everting eyelids in association with a thickened elastic tarsal plate. First described by Cultberston and Ostler over 30 years ago,1 a patient's symptoms are those of ocular irritation, often unilateral and non-specific. The difficulty patients can have describing their ocular problems and the overlap with other causes of ocular irritation mean the condition can often be overlooked or dismissed as trivial in a primary care setting or when presenting to the hospital eye service. Patients are often obese with eyelids which easily evert with minimal traction. Chronic papillary conjunctivitis and lash ptosis may be visible on the affected side.2
Since first being described, FES has been found to be associated with a number of other diseases. The strongest associations identified are with obstructive sleep apnoea (OSA)3–7 and keratoconus.3 In this issue of the BJO Muniesa et al8 provide further supportive evidence by way of a masked cross-sectional study, strengthening the link between OSA and FES. Increased lid laxity occurs with increasing severity of OSA, the prevalence of frank FES ranging from 2.3% to 31.5%;6 ,7 these results are confounded by obesity. Studies have shown FES to be strongly associated with severe OSA3 ,5–8 but the association is not reciprocated.7
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