Purpose

To describe a complex case of giant fornix syndrome (GFS) coexisting with floppy eyelid syndrome (FES) and pellucid marginal degeneration (PMD), and to discuss whether shared systemic risk factors may predispose to combined adnexal, ocular surface and ectatic corneal disease.

---

Methods

A 73-year-old man with diabetes, obesity and obstructive sleep apnoea presented with chronic relapsing purulent conjunctivitis and progressive visual decline. Examination revealed marked eyelid laxity consistent with FES, a deep superior fornix harbouring abundant mucopurulent discharge and a proteinaceous coagulum, conjunctival hyperaemia and punctate keratitis. Corneal evaluation showed features consistent with PMD confirm tomographic basis.

---

Results

Targeted treatment with topical antibiotics, corticosteroids and repeated povidone-iodine irrigation resolved the conjunctival inflammation and restored corneal epithelial integrity within one month. Visual function remained limited by coexisting lens opacity.

---

Conclusion

This case suggests a possible continuum of shared systemic susceptibility – obstructive sleep apnoea, obesity and diabetes acting on both the adnexa and the cornea – rather than a single linear mechanism. Eyelid laxity and a capacious superior fornix favoured stagnation of a bacteria-laden coagulum, perpetuating relapsing purulent conjunctivitis and secondary surface damage; in parallel, the same hypoxic-metabolic milieu is increasingly linked to corneal ectasia. While FES is well associated with keratoconus, the coexistence of PMD here raises the possibility of a broader ectatic susceptibility. Recognising this overlap may improve diagnostic accuracy and guide integrated adnexal and ocular-surface management.

---

Additional Authors

First name	Last name	Base Hospital / Institution
Giuseppe	Giannaccare	Eye Clinic, Department of Surgical Sciences, University of Cagliari, 09124 Cagliari, Italy
Claudia	Tronci	Eye Clinic, Department of Surgical Sciences, University of Cagliari, 09124 Cagliari, Italy;
Alberto	Cuccu	Eye Clinic, Department of Surgical Sciences, University of Cagliari, 09124 Cagliari, Italy;

↑ Back to top