Floppy eyelid syndrome as an indicator of the presence of glaucoma in patients with obstructive sleep apnea.

PURPOSE The aim of the study was to investigate whether floppy eyelid syndrome (FES) could be an indicator of glaucoma in patients with obstructive sleep apnea (OSA). MATERIALS AND METHODS A total of 152 patients were included: 75 patients with OSA and without FES; 52 patients with OSA and FES; and 25 non-OSA patients. The presence of FES was defined by easy upper eyelid eversion and tarsal papillary conjunctivitis. All the patients underwent a complete ophthalmologic examination to diagnose glaucoma; this included computerized perimetry and retinal fiber layer measurements with optical coherence tomography. RESULTS The prevalence of glaucoma in OSA patients without FES was 5.33% (4/75). One patient had primary open-angle glaucoma and 3 had previously diagnosed glaucoma. The prevalence of glaucoma in OSA patients with FES was 23.07% (12/52). Six patients had normal-tension glaucoma, 5 had primary open-angle glaucoma and one patient had previously diagnosed glaucoma. None of the 25 patients without OSA had glaucoma. The difference in the prevalence of glaucoma between OSA patients without FES (5.3%) and OSA patients with FES (23.07%) was statistical significant (P=0.004). When adjustments were made for age and body mass index, this significance remained (P=0.04). CONCLUSIONS These data suggest that FES may offer a useful way to identify individuals with a greater probability of having glaucoma in the OSA population.