Sections

Medication

Medication Summary

The goals of pharmacotherapy for floppy eyelid syndrome (FES) are to reduce morbidity and to prevent complications.

Class Summary

Empiric antimicrobial therapy must be comprehensive and should cover all likely pathogens in the context of the clinical setting.

Erythromycin base (E-Mycin)

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Erythromycin is indicated for infections caused by susceptible strains of microorganisms and for prevention of corneal and conjunctival infections.

Azithromycin ophthalmic (AzaSite)

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This ophthalmic macrolide antibiotic is indicated for bacterial conjunctivitis caused by susceptible strains of microorganisms and for prevention of corneal and conjunctival infections.

Doxycycline (Doryx, Vibramycin, Adoxa)

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Doxycycline inhibits protein synthesis and thus bacterial growth by binding to 30S and possibly 50S ribosomal subunits of susceptible bacteria.

Minocycline (Minocin, Solodyn)

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Minocycline is a member of the tetracycline class of antimicrobial agents. It is a broad-spectrum agent that inhibits susceptible organisms by blocking their protein synthesis.

Class Summary

Lubricants act as humectants in the eye. The ideal artificial lubricant should be preservative-free; contain potassium, bicarbonate, and other electrolytes; and have a polymeric system to increase its retention time. Lubricating drops are used to reduce morbidity and to prevent complications. Lubricating ointments prevent complications from dry eyes. Ocular inserts reduce symptoms resulting from moderate-to-severe dry eye syndromes.

Artificial tears (Advanced Eye Relief, Bion Tears, Hypo Tears, Murine Tears, Tears Naturale II)

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Artificial tears are used to increase lubrication of the eye. Nonpreserved artificial tears are recommended for use. Tears should be applied liberally throughout the day, and, if necessary, a lubricating ointment may be used at night. This ointment may contain an antibiotic preparation.

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McNab AA. Floppy eyelid syndrome and obstructive sleep apnea. Ophthal Plast Reconstr Surg. 1997 Jun. 13(2):98-114. [QxMD MEDLINE Link].
McNab AA. The eye and sleep. Clin Experiment Ophthalmol. 2005 Apr. 33(2):117-25. [QxMD MEDLINE Link].
Karger RA, White WA, Park W, et al. Prevalence of floppy eyelid syndrome in obstructive sleep apnea-hypopnea syndrome. Ophthalmology. Sep 2006. 113(9):1669-74. [QxMD MEDLINE Link].
Chambe J, Laib S, Hubbard J, Erhardt C, Ruppert E, Schroder C, et al. Floppy eyelid syndrome is associated with obstructive sleep apnoea: a prospective study on 127 patients. J Sleep Res. 2011 Oct 11. [QxMD MEDLINE Link].
Muniesa MJ, Huerva V, Sánchez-de-la-Torre M, Martínez M, Jurjo C, Barbé F. The relationship between floppy eyelid syndrome and obstructive sleep apnoea. Br J Ophthalmol. 2013 Apr 12. [QxMD MEDLINE Link].
Pihlblad MS, Schaefer DP. Eyelid laxity, obesity, and obstructive sleep apnea in keratoconus. Cornea. 2013 Sep. 32(9):1232-6. [QxMD MEDLINE Link].
Netland PA, Sugrue SP, Albert DM, et al. Histopathologic features of the floppy eyelid syndrome. Involvement of tarsal elastin. Ophthalmology. 1994 Jan. 101(1):174-81. [QxMD MEDLINE Link].
Schlotzer-Schrehardt U, Stojkovic M, Hofmann-Rummelt C, et al. The pathogenesis of floppy eyelid syndrome: involvement of matrix metalloproteinases in elastic fiber degradation. Ophthalmology. 2005 Apr. 112(4):694-704. [QxMD MEDLINE Link].
Ezra DG, Ellis JS, Gaughan C, Beaconsfield M, Collin R, Bunce C, et al. Changes in tarsal plate fibrillar collagens and elastic fibre phenotype in floppy eyelid syndrome. Clin Experiment Ophthalmol. 2011 Aug. 39(6):564-71. [QxMD MEDLINE Link].
van Nouhuys HM, van den Bosch WA, Lemij HG, Mooy CM. Floppy eyelid syndrome associated with Demodex brevis. Orbit. Sep 1994. 13(3):125-9.
Donnenfeld ED, Perry HD, Gibralter RP, et al. Keratoconus associated with floppy eyelid syndrome. Ophthalmology. 1991 Nov. 98(11):1674-8. [QxMD MEDLINE Link].
Goldberg R, Seiff S, McFarland J, et al. Floppy eyelid syndrome and blepharochalasis. Am J Ophthalmol. 1986 Sep 15. 102(3):376-81. [QxMD MEDLINE Link].
Gonnering RS, Sonneland PR. Meibomian gland dysfunction in floppy eyelid syndrome. Ophthal Plast Reconstr Surg. 1987. 3(2):99-103. [QxMD MEDLINE Link].
Findley LJ, Unverzagt ME, Suratt PM. Automobile accidents involving patients with obstructive sleep apnea. Am Rev Respir Dis. 1988 Aug. 138(2):337-40. [QxMD MEDLINE Link].
Iyengar SS, Khan JA. Quantifying upper eyelid laxity in symptomatic floppy eyelid syndrome by measurement of anterior eyelid distraction. Ophthal Plast Reconstr Surg. 2007 May-Jun. 23(3):255. [QxMD MEDLINE Link].
Schwartz LK, Gelender H, Forster RK. Chronic conjunctivitis associated with 'floppy eyelids'. Arch Ophthalmol. 1983 Dec. 101(12):1884-8. [QxMD MEDLINE Link].
Jordan DR, Anderson RL. The lateral tarsal strip revisited. The enhanced tarsal strip. Arch Ophthalmol. 1989 Apr. 107(4):604-6. [QxMD MEDLINE Link].
Dutton JJ. Surgical management of floppy eyelid syndrome. Am J Ophthalmol. 1985 May 15. 99(5):557-60. [QxMD MEDLINE Link].
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Valenzuela AA, Sullivan TJ. Medial upper eyelid shortening to correct medial eyelid laxity in floppy eyelid syndrome: a new surgical approach. Ophthal Plast Reconstr Surg. 2005 Jul. 21(4):259-63. [QxMD MEDLINE Link].

Media Gallery

Floppy eyelid syndrome. Lax, rubbery upper eyelid is easily everted as it is pulled up toward eyebrow. Conjunctival hypertrophy and inflammation are present, in addition to mucoid discharge.
Floppy eyelid syndrome. Eyelash ptosis in patient with laxity of upper eyelid.

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Author

Mark Ventocilla, OD, FAAO Chief Executive Officer, Elder Eye Care Group, PLC; Chief Executive Officer, Mark Ventocilla, OD, Inc; President, California Eye Wear, Oakwood Optical

Mark Ventocilla, OD, FAAO is a member of the following medical societies: American Academy of Optometry, American Optometric Association

Disclosure: Nothing to disclose.

Coauthor(s)

Andrew A Dahl, MD, FACS Assistant Professor of Surgery (Ophthalmology), New York College of Medicine (NYCOM); Director of Residency Ophthalmology Training, The Institute for Family Health and Mid-Hudson Family Practice Residency Program; Staff Ophthalmologist, Telluride Medical Center

Andrew A Dahl, MD, FACS is a member of the following medical societies: American Academy of Ophthalmology, American College of Surgeons, American Intraocular Lens Society, American Medical Association, American Society of Cataract and Refractive Surgery, Contact Lens Association of Ophthalmologists, Medical Society of the State of New York, New York State Ophthalmological Society, Outpatient Ophthalmic Surgery Society

Disclosure: Nothing to disclose.

Chief Editor

Hampton Roy, Sr, MD † Associate Clinical Professor, Department of Ophthalmology, University of Arkansas for Medical Sciences

Hampton Roy, Sr, MD is a member of the following medical societies: American Academy of Ophthalmology, American College of Surgeons, Pan-American Association of Ophthalmology

Disclosure: Nothing to disclose.

Acknowledgements

Sean M Blaydon, MD, FACS Fellowship Program Director, Texas Oculoplastic Consultants

Sean M Blaydon, MD, FACS is a member of the following medical societies: American Academy of Ophthalmology, American College of Surgeons, American Medical Association, American Society of Ophthalmic Plastic and Reconstructive Surgery, Association of Military Surgeons of the US, International College of Surgeons US Section, Pan-American Association of Ophthalmology, Pan-Pacific Surgical Association, and Texas Medical Association

Disclosure: Nothing to disclose.

Jorge G Camara, MD Professor of Ophthalmology, Department of Surgery and Director of Fellowship Training Program in Ophthalmic Plastic and Reconstructive Surgery for Countries Served by the Aloha Medical Mission, University of Hawaii John A Burns School of Medicine

Jorge G Camara, MD is a member of the following medical societies: American Academy of Ophthalmology, American Medical Association, and American Society of Ophthalmic Plastic and Reconstructive Surgery

Disclosure: Nothing to disclose.

Francisco Talavera, PharmD, PhD Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Medscape Salary Employment

Floppy Eyelid Syndrome Medication

Medication Summary

Antibiotics

Class Summary

Erythromycin base (E-Mycin)

Erythromycin base (E-Mycin)

Azithromycin ophthalmic (AzaSite)

Azithromycin ophthalmic (AzaSite)

Doxycycline (Doryx, Vibramycin, Adoxa)

Doxycycline (Doryx, Vibramycin, Adoxa)

Minocycline (Minocin, Solodyn)

Minocycline (Minocin, Solodyn)

Ophthalmic Lubricants

Class Summary

Artificial tears (Advanced Eye Relief, Bion Tears, Hypo Tears, Murine Tears, Tears Naturale II)

Artificial tears (Advanced Eye Relief, Bion Tears, Hypo Tears, Murine Tears, Tears Naturale II)

Floppy Eyelid Syndrome Medication

Medication Summary

Antibiotics

Class Summary

Erythromycin base (E-Mycin)

Erythromycin base (E-Mycin)

Azithromycin ophthalmic (AzaSite)

Azithromycin ophthalmic (AzaSite)

Doxycycline (Doryx, Vibramycin, Adoxa)

Doxycycline (Doryx, Vibramycin, Adoxa)

Minocycline (Minocin, Solodyn)

Minocycline (Minocin, Solodyn)

Ophthalmic Lubricants

Class Summary

Artificial tears (Advanced Eye Relief, Bion Tears, Hypo Tears, Murine Tears, Tears Naturale II)

Artificial tears (Advanced Eye Relief, Bion Tears, Hypo Tears, Murine Tears, Tears Naturale II)

References

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