What is flopping eye syndrome?

Flopping eye syndrome, accurately known as Floppy Eyelid Syndrome (FES), is a common eye condition defined by excessive looseness of the eyelids (eyelid hyperlaxity) coupled with reactive palpebral conjunctivitis—inflammation of the conjunctiva lining the inside of the eyelids. This condition can lead to significant irritation and discomfort in the eyes.

Understanding Floppy Eyelid Syndrome (FES)

FES is characterized by eyelids that are abnormally pliable and can be very easily everted, often spontaneously during sleep. This laxity, particularly of the upper eyelid, exposes the inner lining of the eyelid (palpebral conjunctiva) to chronic mechanical irritation, especially against bedding or pillows when sleeping on one's side or stomach.

This continuous irritation triggers an inflammatory response in the conjunctiva, leading to what is known as chronic papillary conjunctivitis. The condition is prevalent and, while often underdiagnosed, is a frequent cause of persistent ocular irritation.

Key Characteristics and Presentation

Individuals with Floppy Eyelid Syndrome typically present with a distinct set of symptoms and signs:

• Eyelid Hyperlaxity: The most defining feature is that the eyelids, particularly the upper ones, are extremely loose and can be easily pulled away from the eyeball or turned inside out with minimal effort. This can even occur involuntarily during sleep.
• Chronic Papillary Conjunctivitis: The constant friction and irritation lead to inflammation of the conjunctiva, specifically presenting as chronic papillary conjunctivitis on the upper eyelids. This manifests as small, elevated bumps (papillae) on the inner surface of the eyelid.
• Ocular Irritation: Due to the chronic inflammation and exposure, common symptoms include:
  • Redness of the eyes
  • A gritty or foreign body sensation
  • Watering (epiphora)
  • Mild to moderate discharge, often stringy or mucoid
  • Discomfort that may worsen upon waking

Here's a summary of the main characteristics: