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What is floppy eyelid syndrome?

Floppy eyelid syndrome is a condition where the upper eyelids are relatively loose and can easily be everted (flipped over so they’re turned inside out).

This eyelid eversion can occur during sleep, causing exposure and irritation of the clear front surface of the eye (the cornea) and the inner lining of the eyelid (palpebral conjunctiva).

Causes and risk factors

The cause of floppy eyelid syndrome (FES) is unknown, but it is typically characterized by decreased elastin in the upper eyelids. Elastin is a key protein in the skin that allows it to return to its original shape after it is poked or pinched.

Several conditions are associated with floppy eyelid syndrome, including:

  • Exposure keratitis – inflammation of the cornea due to lack of eyelid coverage

  • Chronic conjunctivitis

  • Keratoconus

  • Lash ptosis – a condition where the eyelashes of the upper lid emerge in a downward direction, so the ends of the lashes point horizontally or downward, rather than upward

  • Obstructive sleep apnea

Top risk factors for FES include being male and obese, and while it’s most common in overweight middle-aged men, FES can affect anyone.

Symptoms of floppy eyelid syndrome

Given the disorder’s name, floppy eyelids are a primary symptom of floppy eyelid syndrome. Those who experience the condition have also described their eyelids as feeling loose and rubbery.

Other symptoms of FES may include:

Irritation and discomfort are often worse upon waking due to the extended contact between the eyelid and the pillow it rests against during sleep. Though FES can occur in one or both eyes, the side of the face one sleeps on is typically more affected.

If you are experiencing any of the symptoms listed above, schedule a comprehensive eye exam with an optometrist or ophthalmologist to determine the root cause of your discomfort.

SEE RELATED: Ptosis (droopy eyelids): Who it affects and when to seek help

Diagnosis

Floppy eyelid syndrome is diagnosed based on medical history, symptoms and appearance, as well as any associated conditions that are present. No laboratory tests or invasive procedures are needed for a floppy eyelid syndrome diagnosis.

Conditions that are sometimes confused with FES include:

  • Ectropion – a sagging of the lower eyelid that creates a gap between the lid and the eye

  • Dermatochalasis – excess, loose skin on or around the eyelids (“baggy eyes”)

  • Conjunctivitis

During a comprehensive exam, your eye doctor will be able to determine if you have floppy eyelid syndrome and discuss the best treatment with you.

Treatment

Depending on the severity of the condition, your eye doctor may recommend a number of treatments, including surgery.

Non-surgical FES treatments include:

  • Lubricating eye drops (natural tears)

  • Eye-safe lubricating ointments

  • Eyelid shields or a firm sleeping mask

  • Taping your eyelids shut before sleep

  • Using a specially shaped pillow to avoid contact between the affected eyelid and your pillow while you sleep

Sleep apnea is often treated in conjunction with floppy eyelid syndrome, as it may also help reduce FES symptoms. If you think you may be experiencing any degree of sleep apnea, see a specialist for proper testing and treatment.

For significant or severe floppy eyelid syndrome, surgery may be needed to tighten the affected eyelid(s). Should this be the case, the specific procedure may also repair ptosis or reposition eyelashes.

In any case, staying up to date with your routine eye exams is crucial to maintaining optimal eye health. An eye doctor will be able to diagnose early signs of floppy eyelid syndrome and recommend the best treatment.

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