Floppy Eyelid Syndrome (FES): Causes, Symptoms, & Treatment

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Floppy eyelid syndrome (FES) refers to a frequently bilateral eyelid malposition that involves the upper eyelids which as result presents chronic ocular surface irritation and chronic papillary conjunctivitis of upper palpebral conjunctiva from severe laxity. Confusing, isn’t it? 

The bookish definition of floppy eyelid syndrome mentioned above might look fancy to read, but understanding it is kind of difficult for someone who isn’t a medical patient but has contracted the disease. To make it easier to understand we will be talking about the syndrome in detail. This article is about floppy eyelid syndrome (FES) which is divided into the following parts.

  1. Background
  2. Experiments
  3. Related researches
  4. Related similar phenomena 
  5. Related Similar Phenomena And Their Causes
  6. Can stress be one of the reasons?
  7. When to see a doctor
  8. Commonly asked questions 
  9. Bottom line

Keep reading to learn everything about floppy eyelid syndrome!


Culbertson and Ostler are the people who first described Floppy eyelid syndrome (FES) in 1981. Floppy eye syndrome was mostly seen in overweight males since their eyelids became floppy, rubbery, and everted. This was associated with chronic papillary conjunctivitis of the upper palpebral conjunctiva.

Due to floppy eyelid syndrome’s symptoms being similar to those of other diseases, it is usually not analyzed at the beginning of indications. Before having a correct and accurate diagnosis, patients suffering from floppy eyelid syndrome can experience vasoconstrictors, artificial tears, steroids, anti-inflammatory drops, or antibiotics.

What Is Floppy Eyelid Syndrome?

Floppy eyelid syndrome (FES) is an under-diagnosed eye illness. This disorder can be recognized by the loose or rubbery texture of the eyelids that can easily flip over. For example, while rolling in bed, your eyelid comes in contact with the cushion.

Who Gets This Syndrome?

The most at risk of the folly eyelid syndrome are overweight, middle-aged men. This is similar to sleep apnea. Floppy eyelid syndrome is associated with keratoconus i.e. visual blurriness such as seeing multiple images at a time, distorted vision, halos, or ghosting, and lash ptosis i.e. eyelash pointing out horizontally or towards the ground out from the eye.

Sleep Apnea in The Floppy Eyelid Syndrome Patients?

Dr. Sutton OD, FAAO, of the Indiana University School of Optometry, recommends patients having floppy eyelid syndrome (FES) get tested for sleep apnea. He says that “The frequency of rest apnea in patients with floppy eyelid disorder (FES) is basically 100%.” 

A recent report took a gander at 102 patients with Floppy Eyelid Syndrome (FES) and a benchmark group of another 102 patients. 90% of study members with floppy eyelid syndrome (FES) additionally had sleep apnea. 

Floppy Eyelid Syndrome: Association

Floppy eyelid syndrome is commonly associated with the following:

  1. Obesity
  2. Gender: Male
  3. Sleep apnea
  4. Down syndrome
  5. Keratoconus 

What Are The Symptoms?

The symptoms of floppy eyelid syndrome include the following:

  1. Tearing
  2. Ropy discharge is usually in the morning after waking up
  3. Inflammation in the eyes (either unilateral or bilateral)
  4. Blurred vision
  5. Morning headache
  6. Daytime fatigue

Related Research on The Floppy Eyelid Syndrome

Research was conducted on floppy eyelid syndrome. I have summarized it to make it easier for the readers!


Pham TT, Perry JD. Floppy eyelid syndrome. Curr Opin Ophthalmol. 2007 Sep;18(5):430-3. doi: 10.1097/ICU.0b013e3282ced08e. PMID: 17700238.


A 2012 investigation of 127 individuals associated with having sleep rest apnea tracked down that 25.8% of those with sleep apnea likewise had Floppy Eyelid Syndrome (FES) and of those with more extreme sleep apnea 40% had Floppy Eyelid Syndrome (FES). The scientists inferred that serious sleep apnea might be a free danger factor for Floppy Eyelid Syndrome (FES). 

Moreover, a recent report took a gander at 102 patients with Floppy Eyelid Syndrome (FES) and a benchmark group of another 102 patients. 90% of study members with floppy eyelid syndrome (FES) additionally had sleep apnea. 

Rundown: Floppy eyelid syndrome (FES) is an underdiagnosed condition. It produces critical visual distortion. Symptoms lie between infrequent redness and bothering the corneal ulcer. The determination depends on visual signs, including simple or unconstrained versions of the upper eyelids related to conjunctivitis and keratitis.

The condition is related to body mass index and obstructive sleep apnea, and ought to be suspected in any overweight patient with a persistent red and tearing eye. Treatment comprises strong estimates like visual oil, eyelid taping or a safeguard, and medical procedures to shield the eyelid tissues.

Floppy Eyelid Syndrome: Etiology

Floppy eyelid syndrome (FES) can happen due to a decrease in elastin content according to a test run on the special stain, electron microscopy, and immunohistochemistry. This reduction in elastin content causes spontaneous eversion of the eyelid that causes chronic irritation as well as inflammation and palpebral conjunctiva causing irritation due to constant rubbing of the palpebral conjunctiva with either your pillow or your bed.

Such rash or rubbery eyes tend to happen to people who sleep on one side more than the other side. This condition prompts corneal and conjunctival trade off, instead of direct mechanical bothering. However, patients who have floppy eyelid syndrome did not have any records of low collagen content.

Floppy Eyelid Syndrome: Pathophysiology

The pathophysiology of Floppy Eyelid Syndrome (FES) and the often experienced visual comorbidities are fundamentally thought to be brought about by mechanical disturbance. The underlying insult is attempted to be persistent mechanical injury from eversion as well as scouring of the eyelid. 

The drawn-out and continuous nighttime eversion brings about exposure keratopathy that is almost generally found in these patients. Constant disturbance and aggravation of the cornea can advance to scarring and neovascularization

Moreover, persistent chronic irritation of the conjunctiva showing as papillary conjunctivitis is often seen, just as meibomitis, eyelash ptosis, and loss of eyelash parallelism

Diagnosis of The Floppy Eyelid Syndrome

Considering the particular rules, the determination of Floppy Eyelid Syndrome ought to be viewed as when a patient presents with any of the symptoms such as tearing, ropy discharge usually in the morning after waking up, inflammation in the eyes (either unilateral or bilateral), blurred vision, morning headache, and daytime fatigue.

The clinical diagnosis of Floppy Eyelid Syndrome is characterized comprehensively as rubbery, flexible, and handily everted upper eyelids. Diagnostic models have been proposed and incorporate target estimations of clinical discoveries like snapback, horizontal distraction, and vertical lid pull.

Treatment of Floppy Eyelid Syndrome:

Floppy eyelid syndrome is treated as inflammation in the eyes with anti-inflammatory eye drops before the proper diagnosis of the patient. In case the patient has sleep apnea and not floppy eyelid syndrome, they can be treated for sleep apnea instead (however, the treatment for sleep apnea will improve the floppy eyelid syndrome too)

Here are three approaches described by Dr. Sutton for Floppy Eyelid Syndrome:

  1. Ointment: a thick lubricating ointment before going to bed.
  2. Pillow: Instead of regular pillows, use cylindrical pillows so that the eye does not come in contact with the pillow while sleeping.
  3. Sleep mask: Use an eye tape or sleep mask to make sure eyelids stay secure and do not flip while sleeping.

In the event that those medicines don’t work, medical procedures to fix the eyelid tissue might be required.

Conclusive Thoughts:

Floppy eyelid syndrome is an underdiagnosed eye illness. Floppy Eyelid Syndrome condition alludes to a regularly respective eyelid malposition that includes the upper eyelids which in outcome presents a constant visual surface disturbance and ongoing papillary conjunctivitis of upper palpebral conjunctiva from serious laxity. 

Culbertson and Ostler are individuals who originally depicted Floppy eyelid disorder in 1981. Floppy eye disorder was generally found in overweight males since their eyelids got floppy, rubbery, and everted. 

A 2012 examination of 127 people related to having rest apnea found that 25.8% of those with rest apnea in like manner had Floppy Eyelid Syndrome and of those with more limited rest apnea 40% had Floppy Eyelid Syndrome.

The clinical finding of Floppy Eyelid Syndrome is portrayed exhaustively as rubbery, adaptable, and helpfully everted upper eyelids. In the event that the patient has rest apnea and is not floppy eyelid condition, they can be treated for rest apnea.

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