Dados do Trabalho

Título

When Ophthalmology Meets Sleep Medicine: Exploring the Relationship Between Floppy Eyelid Syndrome and Obstructive Sleep Apnea

Introdução

A 63-year-old female patient with hypertension, diabetes, and class III obesity was referred to the sleep disorders department with a history of non-restorative sleep. Her Epworth Sleepiness Scale was 8. She is also under ophthalmologic care for right ptosis. Family members noted loud snoring. Physical examination revealed laxity of the right upper eyelid upon upward traction, easy exposure of the tarsal plate and papillary conjunctivitis. She also presented a modified Mallampati score of IV, and a BMI of 42.1 kg/m². She had a past medical history of surgical intervention in her right eyelid in 2021, with reoperation in 2022 due to ptosis recurrence. Obstructive sleep apnea (OSA) associated with Floppy Eyelid Syndrome (FES) was suspected. A type I polysomnography revealed an apnea-hypopnea index (AHI) of 38 events/hour. She spent 98% of the night in the right lateral decubitus position.

Objetivo

Report a case of FES associated to OSA.

Métodos

A literature review was conducted by searching the PubMed database.

Resultados

FES, characterized by upper eyelid laxity and easy eversion, leads to eye exposure during sleep, potentially causing chronic papillary conjunctivitis. Symptoms include ocular irritation, hyperemia, foreign body sensation and xerophthalmia, typically more pronounced upon awakening and on the side most often slept on. Though FES is a common eyelid syndrome with an estimated prevalence of 3.5% to 15.8%, it may be underdiagnosed. There is a strong association between FES and OSA, with studies indicating a prevalence of up to 100% of OSA in FES patients. The pathophysiology of FES is not fully understood. One hypothesis is that OSA patients when sleeping on the lateral or prone position may push the face against the bed surface, pulling the superior eyelid and exposing the conjuntiva. The pressure of the eyelid against the bed surface may result in local ischemia which may be aggravated by intermittent hypoxia during obstructive respiratory events. The resulting oxidative stress may increase matrix metalloproteinases locally, leading to lateral canthal tendon laxity. Initial FES treatment is conservative, including eye drops, artificial tears, and mechanical eyelid occlusion. Treating associated OSA is crucial, as it may reverse the condition. In refractory cases, surgical intervention may be necessary.

Conclusões

In patients with FES, OSA should always be considered due to its high prevalence and the potential for therapeutic benefit.

Palavras -chave

Eyelid Ptosis, Obstructive Sleep Apnea