Corneal biomechanical properties in floppy eyelid syndrome.

PURPOSE: To determine corneal biomechanical properties in patients with floppy eyelid syndrome (FES) and to compare them with eyes of controls. METHODS: This case-control study included 208 eyes (72 eyes with FES and 136 without FES) of 107 patients (37 patients with FES and 70 without FES). Patients underwent a complete clinical eye examination that included corneal biomechanical evaluation carried out with the Reichert Ocular Response Analyzer. RESULTS: Corneal hysteresis (CH), corneal resistance factor (CRF), central corneal thickness (CCT), Goldmann-correlated intraocular pressure (IOPg), and corneal-compensated intraocular pressure (IOPcc) were evaluated. Mean CH was significantly lower in patients with FES than in those without FES (9.51 ± 1.56 vs. 11.66 ± 9.11; P < 0.001). These results remained statistically significant after adjusting for age and apnea-hypoapnea index (AHI) (P = 0.028). Mean CRF was 10.02 ± 2.08 in the group of patients with FES and 11.21 ± 5.36 in the group of patients without FES (P = 0.001). Mean IOPcc was 17.7 ± 4.8 in patients with FES and 16.3 ± 4.4 in those without FES (P = 0.036). After adjusting for age and AHI, these differences in CRF and IOPcc were not statistically significant (P = 0.26 and P = 0.87, respectively). No statistically significant difference was found between patients with and without FES for Goldmann-correlated intraocular pressure or CCT. CONCLUSIONS: Patients with FES had statistically lower CH values. Our findings suggest that corneal biomechanical properties could be changed in patients with FES, reflecting additional structural changes in FES.

Floppy eyelid syndrome as an indicator of the presence of glaucoma in patients with obstructive sleep apnea.

PURPOSE: The aim of the study was to investigate whether floppy eyelid syndrome (FES) could be an indicator of glaucoma in patients with obstructive sleep apnea (OSA). MATERIALS AND METHODS: A total of 152 patients were included: 75 patients with OSA and without FES; 52 patients with OSA and FES; and 25 non-OSA patients. The presence of FES was defined by easy upper eyelid eversion and tarsal papillary conjunctivitis. All the patients underwent a complete ophthalmologic examination to diagnose glaucoma; this included computerized perimetry and retinal fiber layer measurements with optical coherence tomography. RESULTS: The prevalence of glaucoma in OSA patients without FES was 5.33% (4/75). One patient had primary open-angle glaucoma and 3 had previously diagnosed glaucoma. The prevalence of glaucoma in OSA patients with FES was 23.07% (12/52). Six patients had normal-tension glaucoma, 5 had primary open-angle glaucoma and one patient had previously diagnosed glaucoma. None of the 25 patients without OSA had glaucoma. The difference in the prevalence of glaucoma between OSA patients without FES (5.3%) and OSA patients with FES (23.07%) was statistical significant (P=0.004). When adjustments were made for age and body mass index, this significance remained (P=0.04). CONCLUSIONS: These data suggest that FES may offer a useful way to identify individuals with a greater probability of having glaucoma in the OSA population.