CORNEAL DISORDERS IN FLOPPY EYELID SYNDROME

The corneal findings in 60 patients with floppy eyelid syndrome seen a t the Bascom Palmer Eye Institute over a 10-year period were determine d by review of their medical records. Punctate epithelial keratopathy (45%), and both clinical (10%) and subclinical keratoconus were the mo st commonly encountered corneal disorders. Two patients developed prog ressive endotheliopathy (Chandler's syndrome and nonguttate endothelia l dystrophy) during the period of observation. In contrast to previous reports in which almost all patients were obese men, 37% (n = 22) of our patients were women and only 29% of all patients were obese. All p atients slept face down, usually on the most severely affected eye. Tr eatment by lid shortening surgery and/or an eye shield provided sympto matic relief. A pathogenetic theory is advanced that the degenerative changes in the tarsus result from the combination of local pressure-in duced lid ischemia and systemic hypoventilation followed by reperfusio n oxidation injury.