Floppy eyelid Barraquer


Floppy eyelid

What is it?

Floppy eyelid syndrome (SPF, floppy eyelid syndrome), whose cause is not well known, is a disease of the eyelids described in 1981 by Culbertson and Ostler, consisting of hypermobility or sagging eyelid allowing spontaneous eversion in the upper eyelid caused only by contact with the pillow during sleep periods, leading to ocular discomfort.


Clinically patients are mostly middle-aged men with eye problems such as stinging, tearing, red eye typical of chronic conjunctivitis, and usually have been treated with plenty of eye drops without improving. Sometimes they present a characteristic symptom: easy or even spontaneous eversion of the upper eyelid. This eversion occurs often during sleep. The eyelids are "softer" than normal, which will also result in the existence of a ptosis ("fall" of the eyelid), and the appearance of thinner skin, or more wrinkled.

The most common systemic association is hypopnea syndrome, or sleep apnea (OSA). It is characterized by episodes of partial or total collapse of the airway during sleep, causing the patients to wake up constantly, suffering from little rest and daytime sleepiness. OSA affects 2% of women and 4% of men, especially middle-aged and severely overweight. It is also associated with increased risk of hypertension and cardiovascular disease.


Treatment of these patients should include the study of sleep apnea. The definitive diagnosis of OSAS is based on the realization of a polysomnography during sleep, sleep parameters to monitor and assess the impact of episodes of apnea. The use of measures to improve nocturnal oxygenation, such as CPAP (Continuous Positive Airway Pressure), has extraordinary results.

Conservative ocular measures may support the use of ocular lubricants or ocular occlusion overnight.

Combined treatment between local surgery, sleep hygiene (CPAP), and weight loss, is the basis for the evident symptomatic improvement that these patients may have.

Surgery consist of a lateral shortening of the upper eyelid, and improved anchorage of it to the ligaments and orbital bone structures, to prevent pathological lid eversion.


Treatment of apnea and decreased body weight will determine the success of the treatment of ocular disease and factors preventing severe cases.