Floppy Eyelid Syndrome Suggests Presence of Obstructive Sleep Apnea

Ophthalmologists should recommend screening patients with floppy eyelid syndrome for obstructive sleep apnea.

Patients with floppy eyelid syndrome (FES) should be routinely screened for obstructive sleep apnea (OSA) symptoms, as the disorders are commonly comorbid, according to findings published in Ophthalmic Plastic Reconstructive Surgery. 

Researchers conducted a meta-analysis to investigate the prevalence of OSA in patients with FES and to evaluate the severity of OSA with FES prevalence. The study involved searching via Cochrane CENTRAL, Medline, Science Direct, Google Scholar, and PubMed for studies on FES patients and the association with OSA syndrome, published between 1997 and 2022. When there was heterogeneity between students (P <.1) and if I2 values were more than 50%, a random-effects model that weighed the studies was used. All P values were 2-tailed and, if <.05, were considered statistically significant. 

They reviewed 12 studies involving 511 patients (77.6% men; average age, 55.1 years). Overall, 57.1% of participants with FES were found to have OSA. The condition was more prevalent in men by a ratio of 48 to 1. 

Tear film abnormalities were the most common ocular comorbidity (78.9%) followed by keratoconus (20.6%), glaucoma (9.8%), and lower eyelid ectropion (4.6%), of those with FES. The most common systemic morbidity was obesity (43.7%), followed by hypertension (34.0%), and diabetes mellitus (17.9%).

This study confirms the prevalence of OSA in people with FES is dramatically higher than in the general population.

The researchers emphasize that, since ophthalmologists are often an early point of care for patients with FES, measures should be taken to screen those with the disorder for OSA.

“This study confirms the prevalence of OSA in people with FES is dramatically higher than in the general population and needs further acknowledgement by the ophthalmic community.”

Study limitations include selection bias within the included studies, a lack of control group in a majority of studies due to cohort design, and heterogeneity throughout the studies with regard to diagnosis of OSA in patients with FES and other factors.


Bulloch G, Seth I, Alphonse S, et al. Prevalence of obstructive sleep apnea with floppy eyelid syndrome: a systematic review and meta-analysis. Ophthalmic Plast Recontr Surg. Published online October 28, 2022. doi:10.1097/IOP.0000000000002298