Floppy Eyelid Syndrome - a real thing!

How floppy are your eyelids? If you are one of a select few, you may have a clinical diagnosis of Floppy Eyelid Syndrome (FES). This syndrome is, indeed, very real, and it is diagnosed when the upper eyelid is excessively lax and loose. It is most typically found in middle-aged, obese men. You may recall that this group is also the population most likely to suffer from obstructive sleep apnea (OSA). Interestingly, FES has a tie with sleep, since the floppiness usually occurs on the side of the fact that is slept on most often. This suggests a unique role for sleep in the development of FES. Since we know sleep and FES to be related, might sleep apnea play a role in FES?

A group of floppy eyelid and sleep researchers set out to see whether those with FES were likely to have OSA and whether those with OSA were likely to have FES. The researchers first took 8 subjects with already-diagnosed FES and tested them for OSA during an overnight sleep study. Next, 20 already-diagnosed OSA subjects were randomly chosen and screened for FES by a clinician. 

Results showed that only 1 of the 20 OSA subjects suffered from FES, but all 8 of the FES sufferers had OSA! How can this be? These results suggest that not everyone with OSA develops FES, but many or all of the people who do develop FES may have undiagnosed OSA1

But the plot thickens. A subsequent case study was published on this topic that suggested one subject had a reversal of FES after being treated with continuous positive airway pressure (CPAP). That’s right – after 4 years of CPAP treatment, his eyelids were no longer floppy2.

So how do we make sense of all of this? The complicated answer is that oxygen deprivation that accompanies untreated OSA may alter the elasticity of the skin. Given that oxygen deprivation screws up just about everything, this would not be too farfetched. However, the less complicated and perhaps more logical explanation is that those with untreated OSA learn to habitually sleep on one side. In other words, since we know OSA is worse when lying on the back, it may be that OSA subjects develop the tendency to always roll over. Lying to one side would increase the amount of face to pillow time, ultimately creating a little more stretch and a little more floppiness on that side. The message is ultra-clear here: get treated and stick to your treatment!

1. McNab, A. A. (1997). Floppy eyelid syndrome and obstructive sleep apnea. Ophthalmic Plastic & Reconstructive Surgery, 13(2), 98-114.

2. McNab, A. A. (2000). Reversal of floppy eyelid syndrome with treatment of obstructive sleep apnoea. Clinical & experimental ophthalmology, 28(2), 125-126.

Janna Mantua


Janna is a PhD Student / Graduate Research Assistant at University of Massachusetts Amherst with a background in clinical sleep research and psychology. Janna Mantua is a PhD student in the Behavioral Neuroscience department at the University of Massachusetts. Her research focuses on sleep and aging, with specific projects on cognitive health, inflammation, memory formation, and neuroimaging. Prior to her PhD work, Janna was involved in research on sleep apnea and cognitive decline at the NYU Sleep Disorders Center.

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