I’m Dr. Ronan Conlon, an oculoplastic surgeon with 25 years of experience treating Floppy eye syndrome, or FES. While it might seem minor, FES can lead to serious complications if left untreated.

In my comprehensive guide, I’ve detailed the causes, symptoms, and treatments for FES. I’ve also explored its link with obstructive sleep apnea (OSA). Understanding this connection can give you a broader view of your overall health.

Timely intervention is crucial when dealing with FES. With the right information, you can protect your eyes and improve your quality of life. As an experienced surgeon, I’ve seen how prompt action can make a significant difference. I hope this guide helps you understand and manage FES better.

Key Takeaways

  • Floppy Eyelid Syndrome (FES) is characterized by loose, easily everted upper eyelids and decreased elastin.
  • Diagnosing FES relies on subjective evaluation of eyelid eversion and the presence of other clinical features.
  • Early diagnosis is essential to prevent severe complications. Treatments range from eye shields to surgery.

Understanding Floppy Eyelid Syndrome

Symptomatic floppy eyelid syndrome, also known as lax eyelid syndrome or floppy eyelid syndrome (FES), is a condition characterized by:

  • Loose, easily everted upper eyelids
  • Decrease in elastin in the upper eyelids
  • Irritation and damage to the cornea and conjunctiva
  • Poor tear film spreading
  • Ocular surface disease (OSD)

The exact cause of FES remains unknown, but its development is typically linked to a decrease in elastin in the upper eyelids.

Timely identification and appropriate intervention are key in controlling FES and avoiding complications.

Characteristics of FES

The primary characteristics of FES include lax and easily everted upper eyelids, persistent irritation, and papillary conjunctivitis. Patients with FES often experience floppy eyelids, a loose and rubbery sensation in their eyelids, eye redness, irritation, itching, tearing, and discharge. Diagnosing FES relies on a subjective evaluation of upper eyelid eversion and the presence of other clinical features, such as obstructive sleep apnea syndrome.

Knowledge of FES symptoms and characteristics aids in correct diagnosis and treatment. Prompt intervention can prevent severe eye-related complications and enhance patients’ quality of life.

Prevalence and demographics

While measuring the exact prevalence of FES in the general population is difficult, estimates range from 2.3% to 3.8%. FES is predominantly associated with middle-aged overweight males, but can also affect females and, in rare cases, the pediatric population.

Notably, FES is far less frequently observed in East Asians. Recognizing the demographics and risk factors linked to FES can promote awareness and facilitate early detection.

The Connection Between Floppy Eyelid Syndrome and Obstructive Sleep Apnea

Many individuals with FES also suffer from obstructive sleep apnea (OSA), a sleep disorder characterized by loud snoring and disturbed sleep. In a study conducted in 2012, 25.8% of people with OSA, had FES, which increased to 40% among those with more severe OSA.

Understanding the link between FES and OSA aids in precise diagnosis and effective treatment, as managing sleep apnea can improve FES.

Shared symptoms

Both FES and OSA share symptoms such as:

  • Heavy snoring
  • Disrupted sleep patterns
  • Eye irritation
  • Redness
  • Discharge
  • Easily everted eyelids during sleep

Recognizing these shared symptoms is vital for correct diagnosis and following treatment, as it enables healthcare professionals to identify and manage both conditions simultaneously.

Furthermore, early recognition of the common symptoms between FES and sleep apnea hypopnea syndrome is pivotal in preventing serious, sight-threatening and life-threatening conditions. As a result, individuals experiencing these symptoms should seek medical advice promptly to ensure the best possible outcomes.

Importance of early diagnosis

Prompt diagnosis of FES is critical, as it facilitates immediate intervention and management of the condition, helping to hinder FES progression, prevent severe eye-related complications, and avoid the need for more invasive treatments.

Moreover, early diagnosis of this eyelid disorder enables healthcare professionals to identify any associated ocular or systemic diseases, such as keratoconus and OSA, which may require additional treatment.

Symptoms and Clinical Features of Floppy Eyelid Syndrome

Typical signs of Floppy Eyelid Syndrome include recurrent or persistent ocular surface irritation, chronic papillary conjunctivitis of the upper palpebral conjunctiva, and severe eyelid laxity.

If you show symptoms of Floppy Eyelid Syndrome, it’s important to schedule a comprehensive eye examination with an optometrist or ophthalmologist to pinpoint the cause of your discomfort. Familiarizing with the symptoms of this eyelid disorder and the clinical features of Floppy Eyelid Syndrome aids in accurate diagnosis and effective management of the condition.

Floppy Eyelid Syndrome patients often experience eye-specific symptoms like:

  • redness
  • Papillary conjunctivitis
  • irritation
  • tearing
  • discharge
  • blurred vision

These symptoms are usually caused by prolonged contact between the eyelid and the pillow during sleep, leading to chronic irritation, and papillary conjunctivitis affecting the undersurface of the upper eyelid. The persistent discomfort and irritation can significantly impact a patient’s quality of life, making it crucial to seek medical help immediately.

Acting swiftly with appropriate treatment is key to controlling Floppy Eyelid Syndrome and avoiding complications. Non-invasive methods like eye shields, taping, and topical lubricants can help lessen symptoms, whereas severe cases might need surgical intervention. By tackling the eye-related symptoms of Floppy Eyelid Syndrome, patients can achieve relief and improved eye health.

Systemic symptoms

In addition to eye-related symptoms, FES patients may experience systemic symptoms such as fatigue, sleep disturbances, and weight gain. These symptoms can further impact a patient’s overall health and well-being.

Tackling both the ocular and systemic symptoms of FES is key for a holistic treatment plan to enhance the patient’s quality of life.

Diagnosing Floppy Eyelid Syndrome

Diagnosing FES primarily involves reviewing the patient’s history, clinical features, and any associated systemic conditions. No laboratory tests or invasive procedures are required for diagnosis. Instead, a thorough ophthalmological exam focuses on testing eyelid laxity.

Comprehending the diagnostic process and tests available assists patients and healthcare professionals in accurately detecting and managing FES.

Physical examination

During a physical examination for FES, the primary focus is on testing eyelid laxity. Clinicians will note the presence of rubbery, malleable, and readily evertable upper eyelids as an indicator of FES. Prompt diagnosis is vital to avert further complications and secure the most positive outcome for the patient.

In addition to evaluating eyelid laxity, clinicians may also examine the patient for other clinical signs associated with FES, such as conjunctivitis, dermatochalasis, and ectropion. By conducting a comprehensive physical examination, healthcare professionals can accurately diagnose FES and develop an appropriate treatment plan.

Measurement tests

Several measurement tests can be used to evaluate eyelid laxity and anterior eyelid distraction in FES patients, including quantifying upper eyelid laxity. These tests consist of the McNab AA method, UEDA test, and vertical hyperlaxity test.

These diagnostic tools can help clinicians assess the severity of FES and determine the most suitable treatment options for each patient.

Differential Diagnosis

Differential DiagnosisDescription
BlepharochalasisIntermittent swelling of the upper eyelids leading to skin thinning and redundancy.
DermatochalasisExcess upper or lower eyelid skin, often due to aging.
PtosisDrooping or falling of the upper eyelid.
Chronic Allergic ConjunctivitisChronic rubbing can lead to eyelid laxity.
Horner’s SyndromeA neurological disorder causing ptosis.
Myasthenia GravisA neuromuscular disorder leading to ptosis.
Third Nerve PalsyA neurological condition causing ptosis.
Contact Lens WearChronic use can lead to eyelid laxity.
Ehlers-Danlos SyndromeA connective tissue disorder causing skin and eyelid laxity.
Cutis LaxaA rare connective tissue disorder with loose, sagging skin.
TraumaChronic rubbing or trauma can lead to eyelid laxity.
Post-surgical changesPrevious surgeries can lead to eyelid laxity.
AgingNatural aging can decrease eyelid tissue elasticity.

Non-Surgical Treatment Options for Floppy Eyelid Syndrome

A person's eye with medical treatment for floppy eyelid syndrome
Eversion of the upper eyelid demonstrating papillary conjunctivitis

Non-surgical treatment options for FES include:

  • Eye shields
  • Taping
  • Topical lubricants
  • CPAP therapy

These treatments can help manage the condition and alleviate symptoms without invasive procedures.

Before contemplating surgery, patients and healthcare professionals should investigate all available non-invasive treatment options.

Medical therapy

Potential medical treatments for FES include:

  • Eye shields, which may protect the eyes from further damage
  • Taping, which can help reduce inflammation
  • Topical lubricants, which can lubricate the ocular surface

In addition to these treatments, CPAP therapy can also be beneficial for managing FES. This therapy involves using a machine to provide continuous air pressure to the airways, helping to maintain open airways and reduce FES symptoms.

Medical therapy and lifestyle modifications can notably enhance FES patients’ quality of life. By considering these non-invasive treatment options, patients can control their symptoms and prevent complications without resorting to invasive procedures.

Lifestyle changes

Lifestyle modifications can significantly manage FES by reducing associated risk factors with this eyelid disorder. This includes weight reduction, enhanced sleep hygiene, and frequent eye examinations.

Weight loss can decrease pressure on the eyelids, alleviating symptoms related to FES. Enhanced sleep hygiene can also help reduce eyelid pressure and mitigate FES symptoms. Regular eye examinations can aid in early diagnosis and prevent complications associated with FES.

Surgical Management of Floppy Eyelid Syndrome

Surgery may be necessary to treat FES when non-surgical treatments are unsuccessful. Various surgical techniques have been proposed to correct upper eyelid laxity in FES patients, focusing on resolving the upper eyelid’s spontaneous eversion.

The decision to opt for surgery should be thoughtfully weighed and deliberated with a medical professional to ascertain the most suitable course of action.

Lateral upper eyelid shortening

Medial upper eyelid shortening is a surgical method to address lateral eyelid laxity in people suffering from FES. It is used to correct medial eyelid laxity and improve vision. This procedure is effective in reducing eyelid laxity and improving patients’ vision. Medial upper eyelid shortening may be a suitable treatment option for patients who have not experienced relief from non-surgical treatments.

In addition to medial upper eyelid shortening, surgical techniques such as lateral tarsal strip, lateral canthal tendon plication, and full-thickness wedge excision have been proposed to treat FES. Patients considering surgery should discuss all available options with their healthcare provider to determine the most appropriate treatment plan.

Alternative surgical approaches

Modified surgical techniques like FESplasty and concurrent correction of associated eyelid malpositions have been developed to treat FES, often related to acquired lax eyelid syndrome. These alternative approaches aim to provide more targeted treatment for FES patients, addressing both eyelid laxity and related complications.

Plastic surgeons specializing in eyelid surgery can help determine the most suitable surgical approach for each patient based on their unique needs and circumstances.


In conclusion, understanding the causes, symptoms, and treatment options for floppy eyelid syndrome is essential for effectively managing and preventing complications. By recognizing the connection between FES and obstructive sleep apnea, healthcare professionals can address both conditions simultaneously, leading to improved patient outcomes. With accurate diagnosis and timely intervention, patients can protect their eyes and enhance their overall quality of life.

Frequently Asked Questions

What causes floppy eye syndrome?

Floppy Eye Syndrome (FES) is linked to keratoconus, caused by mechanical irritation from eye rubbing and inadequate spreading of the tear film due to poor apposition of the lax upper eyelid.

It has also been connected to obesity, males, obstructive sleep apnea, Downs syndrome and keratoconus.

How do you treat floppy eye syndrome?

Floppy Eye Syndrome can be treated by avoiding rubbing the eyelid, using ocular lubricants and antihistamines, taping the eye shut at night, and using an eye shield to prevent overnight eversions.

In more severe cases, surgical tightening may be necessary.

How is floppy eyelid syndrome diagnosed?

Floppy eyelid syndrome is typically diagnosed through a combination of patient history, clinical features, and any systemic conditions.

An ophthalmological exam then tests for eyelid laxity to confirm the diagnosis.

What lifestyle changes can help manage FES?

Weight reduction, improved sleep habits and regular eye exams are recommended to help manage FES and reduce risk factors associated with the condition.

Are there alternative surgical approaches for treating FES?

There are alternative surgical approaches for treating FES such as lateral tarsal strip, lateral canthal tendon plication, full-thickness wedge excision, and modified techniques like FESplasty.

Here are five reputable sources of information for patients seeking knowledge about ……..

  1. American Academy of Ophthalmology: They provide a comprehensive overview of Floppy Eyelid Syndrome, its symptoms, causes, and treatment options. Website: www.aao.org
  2. National Institutes of Health (NIH): The NIH provides scientific and medical research information about various health conditions, including Floppy Eyelid Syndrome. Website: www.nih.gov
  3. Mayo Clinic: They provide detailed information about the symptoms, causes, and treatments for Floppy Eyelid Syndrome. Website: www.mayoclinic.org
  4. MedlinePlus: A service of the U.S. National Library of Medicine, it provides information about diseases, conditions, and wellness issues in language that is easy to understand. Website: medlineplus.gov
  5. American Optometric Association: They provide reliable information about various eye conditions, including Floppy Eyelid Syndrome. Website: www.aoa.org

Photo graph of Dr. Conlon operating with loops on.

Dr. M. Ronan Conlon started his career in the field of ophthalmology at the same time as the development of refractive eye surgery in Canada. In 1996, he brought laser technology to Canada from Germany, which allowed him to perform laser eye surgery before it was available in the United States. With the establishment of the Conlon Eye Institute, Dr. Conlon has performed more than 40,000 refractive procedures and has advanced his expertise in LASIK, Refractive Cataract Surgery, and oculoplastic surgery.

The information on this page should not be used in place of information provided by a doctor or specialist.


Latest Posts