Floppy Eyelid Syndrome Workup

Updated: Jul 20, 2018
  • Author: Mark Ventocilla, OD, FAAO; Chief Editor: Hampton Roy, Sr, MD  more...
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Approach Considerations

In patients with floppy eyelid syndrome (FES), conjunctival scrapings may show the following [17] :

  • Predominance of polymorphonuclear leukocytes (PMNs) with variable amounts of eosinophils and lymphocytes

  • Papillary conjunctival hypertrophy

If obstructive sleep apnea is suspected, the patient should be referred for polysomnography (sleep study).

The tear break-up test (TBUT) result may be less than 10 seconds in FES, indicating tear instability (normal TBUT result, 15-20 seconds).

Light microscopy of surgical specimens may reveal the following:

  • Usual findings of chronic conjunctival inflammation

  • Abnormalities of the meibomian glands, such as granuloma formation

  • Decrease in tarsal elastin