Purpose

Floppy eyelid syndrome (FES) is a rare condition which is often undiagnosed. In our case study we aim to point out that this disorder can lead to serious corneal involvement if not recognised and treated in time.

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Methods

We report two cases in which FES was the only recognisible cause of severe corneal thinning till perforation. Rheumatological workout excluded the presence of associated autoimmune diseases.

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Results

A 81-old lady presented with corneal ulcera and thinning in her left eye. Ophthalmological examination revealed marked FES with complete eversion of the upper and lower lid and severe papillary conjunctivitis. Intensive medical therapy of eye surface, lateral tarsal strip and eye lid shortening was performed, as well as amnion membrane bandage of the cornea. Her body max index was in normal range (25,4), a sleep apnea test was requested by hospital discharge. One month later she presented with corneal melting in the right eye. Repeated rheumatological workout couldn’t find any autoimmune disease. Because of severe corneal melting, a scleral patch was required.
The second case was a 74-years old lady with a large, sterile corneal ulcer in the right eye. She had only mild lid eversion on intended eye closure and moderate papillary conjunctivits. An ENT examination showed an obstruction in the right nasal cavity making she breahting only through the mounth. She required a lateral tarsal strip and an amnion membrane bandage (sandwich technique) in the short term.

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Conclusion

We present two atypical cases of floppy eyelid syndrome (women, no obesity, moderate lid findings in the second case) with severe corneal disorders like corneal melting and perforation. There were no other plausible causes for these corneal conditions that FES. This study underline that floppy eyelid syndrome should be early recognized and properly treated to avoid sight-threatening complications.

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Additional Authors

First name	Last name	Base Hospital / Institution
Hagen	Thieme	University Eye Hospital Magdeburg
Vivien	Mielke	University Eye Hospital Magdeburg

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