Acquired lax eyelid syndrome: An unrecognized cause of the chronically irritated eye

Department of Ophthalmology and Visual Sciences, University of Wisconsin-Madison, Madison, WI 53792, USA.
Ophthalmic Plastic and Reconstructive Surgery (Impact Factor: 0.88). 02/2005; 21(1):52-8. DOI: 10.1097/01.IOP.0000150360.84043.2E
Source: PubMed


To describe the demographics, symptoms, and findings of acquired lax eyelid syndrome and to assess the efficacy of the 4-eyelid tarsal strip-periosteal flap technique to treat horizontally lax upper and lower eyelids.
A retrospective, case-series review of 80 patients (320 eyelids) evaluated from January 2000 to April 2004 for lax upper and lower eyelids causing chronic irritation was performed. Ten patients with diagnosed floppy eyelid syndrome or obstructive sleep apnea were excluded. Height and weight of all patients were recorded to calculate body mass index. Lateral tarsal strip fixation of all 4 eyelids to periosteal flaps based inside the orbital rim was performed to achieve horizontal tightening. Postoperative follow-up ranged up to 52 months. Preoperative/postoperative symptoms and examination findings of upper and lower eyelid distraction, keratopathy, and conjunctival inflammation were compared.
The most common presenting symptoms were epiphora (85.7%) and irritation (80%). The most common examination findings were upper and lower eyelid horizontal laxity and palpebral conjunctival injection (100% patients). Thirteen of 70 patients (18.6%) were obese, based on body mass index; 26 of 70 patients (37.1%) were mildly overweight; 29 of 70 patients (41.4%) were normal weight; and 2 of 70 patients (2.9%) were underweight. After surgery, 91% of patients had improved or resolved symptoms and signs; 2.5% of dehiscences occurred with the use of the 4-eyelid technique. Gradual continued improvement was observed for up to 1 year.
Evaluation of patients presenting with chronically irritated eyes should include distraction of both the upper and lower eyelids and examination for conjunctival inflammation. Acquired lax eyelid syndrome is similar to floppy eyelid syndrome; however, 43.3% of patients were normal weight or underweight. The 4-eyelid tarsal strip-periosteal flap fixation is a rapid and effective technique for correction of this syndrome.

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    • "Epiphora is one of the most common ophthalmic symptoms.[12] Although, it can be produced by lacrimal hyper-secretion (due to inflammatory or irritative conditions)[3] or to eyelid malpositions (such as ectropion or entropion),[45] it is usually associated with defective lacrimal outflow.[12] The anatomical lacrimal outflow route includes the upper and lower lacrimal puncta, upper and lower canaliculi, common canaliculus, lacrimal sac (LS) and nasolacrimal duct [Figure 1].[12] Various valve-like formations are located along this route, especially at the common canliculus and lower end of the nasolacrimal duct (Rosenmuller and Hasner valves, respectively).[12] "
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    ABSTRACT: To verify whether the tarsal strip procedure improves epiphora of patients with eyelid laxity but no ectropion. A retrospective study was done with a sample of epiphora patients with lax eyelids in normal position and no nasolacrimal obstruction who were operated on with the tarsal strip technique. Fourteen lower eyelids, in 11 patients, were included in the study. Epiphora in ten eyes (71.4%) completely or significantly improved after a follow-up of three months. Eyelid laxity disappeared in all cases. In patients with epiphora, lax eyelids and patent lacrimal ducts, the tarsal strip procedure can significantly improve epiphora in most cases. As laxity ceased to exist in all eyelids, an assumption can be made that in some of the failures there may be other causes, concomitant with eyelid laxity, to explain perseverance of epiphora.
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