title: The associations of floppy eyelid syndrome: a case control study.
abstract: OBJECTIVE
  To describe the demographic features of a large series of patients with floppy eyelid syndrome (FES) and to investigate the associations of the condition with keratoconus, obstructive sleep apnea-hypopnea syndrome (OSAHS), and a variety of upper and lower eyelid features.
  
  
  METHODS
  Case control study.
  
  
  METHODS
  The test group comprised 102 patients with FES. A control group of 102 patients were recruited from a diabetic retinopathy clinic and matched on a 1:1 basis on age, gender, and body mass index (BMI).
  
  
  METHODS
  A full medical and ophthalmic history was taken. Patients also underwent a full ocular examination, including an assessment of upper and lower lid laxity and upper lid levator function. Keratoconus grading was made using the Oculus Instruments Pentacam imaging system (Oculus Optikgerate GmbH, Wetzlar, Germany). Patients were screened for OSAHS using the Epworth daytime somnolence score. Matched statistical analysis of dichotomous data was made using Mantel-Haenszel methods for odds ratios and McNemar's test. Analysis of continuous data was performed using a matched t test and tests for symmetry of larger tables were made using the McNemar-Bowker test.
  
  
  METHODS
  The significance of association of FES with keratoconus, OSAHS, smoking history, medial and lateral canthal laxity of the upper and lower lids, levator function, lash ptosis, and dermatochalasis.
  
  
  RESULTS
  Significant associations were found between FES and OSAHS (P = 0.0008), keratoconus (P<0.0001), lash ptosis (P<0.0001), dermatochalasis (P = 0.02), upper lid medial canthal laxity (P = 0.02), upper lid distraction (P = 0.001), palpebral aperture (P = 0.004), and levator function (P = 0.005).
  
  
  CONCLUSIONS
  Floppy eyelid syndrome seems to be a condition strongly associated with OSAHS and keratoconus. As well as providing a platform for an etiologic hypothesis for the condition, these findings should also encourage clinicians to be aware of these associations and to direct further treatment.
  
  
  BACKGROUND
  The author(s) have no proprietary or commercial interest in any materials discussed in this article.
authors.affiliation: National Institute for Health Research Biomedical Research Centre for Ophthalmology, 2nd Floor Richard Desmond Childrens Eye Centre, Moorfields Eye Hospital and UCL Institute of Ophthalmology, NHS Foundation Trust, London, United Kingdom. d.ezra@ucl.ac.uk
authors.forename: Daniel G
authors.initials: DG
authors.lastname: Ezra
authors.forename: Michèle
authors.initials: M
authors.lastname: Beaconsfield
authors.forename: Mano
authors.initials: M
authors.lastname: Sira
authors.forename: Catey
authors.initials: C
authors.lastname: Bunce
authors.forename: Richard
authors.initials: R
authors.lastname: Wormald
authors.forename: Richard
authors.initials: R
authors.lastname: Collin
mesh_terms: D015992:Body Mass Index; D016022:Case-Control Studies; D005141:Eyelid Diseases / Q000150:complications* / Q000175:diagnosis; D005143:Eyelids / Q000473:pathology; D005260:Female; D006801:Humans; D007640:Keratoconus / Q000150:complications*; D008297:Male; D008875:Middle Aged; D020181:Sleep Apnea, Obstructive / Q000150:complications*; D012907:Smoking; D013577:Syndrome