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).
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
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.
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
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.
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.
Page published in September 2020
Page updated in February 2021