Soha Noorani

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Introduction:Floppy Eyelid Syndrome (FES) describes the disease process whereby extreme laxity of the eyelid can lead to recurrent irritation of the ocular surface and corresponding palpebral keratoconjunctivitis1,2. Clinical exam characteristically reveals an eyelid that is easy to evert with traction superiorly2. However, FES can masquerade as conditions such as dry eye syndrome, keratitis, conjunctivitis, and dermatochalasis1-3. Incidence in the general population has been estimated to range from 2.3% to 15.8%, though notably it may not always be correctly diagnosed and may be more common1,2.We describe a case of unilateral and chronic keratoconjunctivitis unresponsive to standard medical therapy. Applying upward traction on the upper eyelid confirmed the diagnosis, as it revealed extensive laxity of the tarsal plate with resultant lagophthalmos and exposure keratopathy. Tape splint tarsorrhaphy (TST) has been recently described as a novel and non-invasive treatment modality for persistent corneal epithelial defects4. In this case, the TST was used as a novel and non-invasive diagnostic and temporizing tool to splint the eyelid down to address exposure keratopathy from lagophthalmos. Resolution of signs and symptoms was diagnostic and therapeutic confirmation that the keratoconjunctivitis resulted from the lagophthalmos and FES. This is the first such report to our knowledge discussing the specific use of this technique to more effectively diagnose refractory keratoconjunctivitis due to lagophthalmos and FES.