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Abstract

We would like to thank Detorakis et al for their points regarding the observation of lateral ptosis and lateral canthal laxity in patients with floppy eyelid syndrome (FES). In our case control study, we did indeed find that medial canthal laxity was significantly associated with FES when compared with the control group. The presence of lateral canthal laxity was not found to be significantly associated, although it must be noted that the study was not powered to discern these parameters.1Ezra D.G. Beaconsfield M. Sira M. et al.The associations of floppy eyelid syndrome: a case control study.Ophthalmology. 2010; 117: 831-838Abstract Full Text Full Text PDF PubMed Scopus (57) Google Scholar Concurrent lateral canthal laxity and ptosis may indeed be a feature of FES as the lateral canthal tendon accepts insertions from the lateral levator aponeurosis.2Ezra D.G. Beaconsfield M. Collin R. Surgical anatomy of the upper eyelid: old controversies, new concepts.Expert Rev Ophthalmol. 2009; 4 (47–7)Crossref PubMed Scopus (14) Google Scholar However, the specificity and sensitivity of this feature are questionable as ptosis is a common sequela of mechanical trauma to the upper lid and is present in a range of conditions.In our study, we found that some patients had medial canthal laxity and others lateral canthal laxity with often remarkable sparing of the fellow tendon. It is important to check for both medial and lateral canthal laxity carefully before planning surgery. In our sister paper, we discussed the importance of addressing the anatomically lax area to determine the appropriate surgical approach to treatment.3Ezra D.G. Beaconsfield M. Sira M. et al.Long-term outcomes of surgical approaches to the treatment of floppy eyelid syndrome.Ophthalmology. 2010; 117: 839-846Abstract Full Text Full Text PDF PubMed Scopus (22) Google Scholar We welcome the observations of Decorates et al, which may alert clinicians to the presence of lateral canthal laxity in FES patients, and we emphasise that assessing canthal laxity is essential in determining the surgical strategy. We would like to thank Detorakis et al for their points regarding the observation of lateral ptosis and lateral canthal laxity in patients with floppy eyelid syndrome (FES). In our case control study, we did indeed find that medial canthal laxity was significantly associated with FES when compared with the control group. The presence of lateral canthal laxity was not found to be significantly associated, although it must be noted that the study was not powered to discern these parameters.1Ezra D.G. Beaconsfield M. Sira M. et al.The associations of floppy eyelid syndrome: a case control study.Ophthalmology. 2010; 117: 831-838Abstract Full Text Full Text PDF PubMed Scopus (57) Google Scholar Concurrent lateral canthal laxity and ptosis may indeed be a feature of FES as the lateral canthal tendon accepts insertions from the lateral levator aponeurosis.2Ezra D.G. Beaconsfield M. Collin R. Surgical anatomy of the upper eyelid: old controversies, new concepts.Expert Rev Ophthalmol. 2009; 4 (47–7)Crossref PubMed Scopus (14) Google Scholar However, the specificity and sensitivity of this feature are questionable as ptosis is a common sequela of mechanical trauma to the upper lid and is present in a range of conditions. In our study, we found that some patients had medial canthal laxity and others lateral canthal laxity with often remarkable sparing of the fellow tendon. It is important to check for both medial and lateral canthal laxity carefully before planning surgery. In our sister paper, we discussed the importance of addressing the anatomically lax area to determine the appropriate surgical approach to treatment.3Ezra D.G. Beaconsfield M. Sira M. et al.Long-term outcomes of surgical approaches to the treatment of floppy eyelid syndrome.Ophthalmology. 2010; 117: 839-846Abstract Full Text Full Text PDF PubMed Scopus (22) Google Scholar We welcome the observations of Decorates et al, which may alert clinicians to the presence of lateral canthal laxity in FES patients, and we emphasise that assessing canthal laxity is essential in determining the surgical strategy. Blepharoptosis and Floppy EyelidOphthalmologyVol. 117Issue 11PreviewWe read with interest the recent article by Ezra et al1 concerning the associations of floppy eyelid syndrome (FES). FES is not uncommon in our own clinical practice and, as previously reported,2 many cases we encounter were previously misdiagnosed or considered unspecified chronic ocular surface inflammations. Taking into account the important systemic associations of FES, such as the obstructive sleep-apnea syndrome and the risks they carry, the early recognition of the condition is of high clinical value. Full-Text PDF