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Blepharoplasty
Published in John C Watkinson, Raymond W Clarke, Terry M Jones, Vinidh Paleri, Nicholas White, Tim Woolford, Head & Neck Surgery Plastic Surgery, 2018
The degree of upper eyelid laxity is assessed to ensure that a ‘floppy eyelid syndrome’ is not overlooked. This is done by pulling downwards on the eyelid after grasping the eyelid margin and the eyelashes in the lateral aspect of the eyelid. Excessive eyelid laxity is also evident if eversion of the upper eyelid is very easy to perform.
How to master MCQs
Published in Chung Nen Chua, Li Wern Voon, Siddhartha Goel, Ophthalmology Fact Fixer, 2017
In epiblepharon there is excess pre-tarsal skin and orbicularis oculi. This can cause misdirection of the eyelashes, resulting in corneal irritation and punctate keratitis. Dermatochalasis is seen in the elderly due to excess upper lid skin. Overhanging of the skin can cause superior visual field defects. Blepharochalasis affects younger people with recurrent inflammation and swelling of the upper lid. This can lead to loosening of the skin and levator dehiscence. It is not caused by allergy. Floppy eyelid syndrome typically affects middle-aged overweight males. The upper lid everts easily during sleep, causing mechanical irritation. Chronic papillary conjunctivitis and punctate keratitis are common. Brow ptosis can be involutional or the result of facial nerve palsy.
Upper blepharoplasty: advanced techniques and adjunctive procedures
Published in Expert Review of Ophthalmology, 2023
Parya Abdolalizadeh, Mohsen Bahmani Kashkouli, Vahid Khamesi, Nasser Karimi, Hossein Ghahvehchian, Leila Ghiasian
Floppy eyelid syndrome mainly involves the upper eyelids that easily distort and turn out with minimal lateral traction and the tarsus appears soft, rubbery, and easily folded. There are various methods to measure the upper eyelid laxity such as upper eyelid vertical distraction test, upper eyelid horizontal distraction test and snap back test [111]. In subjects with floppy eyelid syndrome, upper blepharoplasty should be combined with procedures to correct upper eyelid laxity including the full-thickness wedge excision of the tarsus [112], medial and lateral canthal ligament ligation [112,113], lateral tarsal strip with periosteal flap [114], and conchal cartilage graft reinforcement. Ezra et al. [112] showed that medial or lateral canthal plication have better long-term outcomes than wedge excision procedure in patients with floppy eyelids.
The role of lid margin structures in the meibomian gland function and ocular surface health
Published in Expert Review of Ophthalmology, 2021
Sezen Karakus, Xi Dai, Xi Zhu, John D Gottsch
The eyelashes are nearly always curved in individuals [18]. A downward vertical malposition of the eyelashes is called lash ptosis and may be an indicator of structural abnormalities [22]. (Figure 3) Excess skin or fatty tissue, such as in dermatochalasis, is the most common reason for lash ptosis [22]. Floppy eyelid syndrome is another condition that is associated with lash ptosis. In fact, lash ptosis and the loss of eyelashes are characteristics of the syndrome. Eyelid laxity in floppy eyelid syndrome due to elastin deficiency in the tarsal plate is responsible for the altered direction of the eyelashes [23–25]. Lash ptosis may be an indicator of reduced tension of orbicularis oculi and Riolan’s muscle, which can explain meibomian gland dysfunction even if the orifices are not obstructed.
Prospective Evaluation of Floppy Eyelid Syndrome at Baseline and after CPAP Therapy
Published in Current Eye Research, 2021
Maria J. Vieira, Maria J. Silva, Nádia Lopes, Cláudia Moreira, Fausto Carvalheira, João Paulo Sousa
Obstructive sleep apnea (OSA) is a sleep disorder characterized by nocturnal pharyngeal collapse that leads to partial airway obstruction and hypopnea or apnea during sleep.1 Associated ocular complications including floppy eyelid syndrome (FES).2 FES was first described in 1981 by Culbertson and Ostler3 as a clinical entity consisting of rubbery, floppy upper eyelids that can be easily everted by upward traction or that evert spontaneously during sleep;4 the condition is associated with papillary conjunctivitis of the upper palpebral conjunctiva. Patients with FES are mostly middle-aged, overweight men5 with alterations affecting the eyelid (ptosis, lash ptosis, blepharitis, and upper and lower eyelid entropion)6 or other structures of the eye (papillary conjunctivitis, superficial punctate keratopathy, scarring, corneal neovascularization, keratoconus, progressive epitheliopathy, and even corneal perforation).7