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.