Floppy eyelid syndrome

Abstract

The article “A New Physical Finding in Floppy Eyelid Syndrome” by Langford and Linberg (Ophthalmology 1998;105:165–9) rightly emphasizes the consistency with which eyelash ptosis is seen in this condition. To claim it as a “new” physical finding, however, is a little unfair to those who have previously described it as a feature of floppy eyelid syndrome (FES). The clinical feature described as “eyelash ptosis with loss of eyelash parallelism” is, I am sure, the same thing observed by other authors and described as lash ptosis, but it is more elegantly and completely described by Langford and Linberg. As the authors state, eyelash ptosis has been described in 8% of 113 cases found in their literature search. In my thesis for membership of the American Society of Ophthalmic Plastic and Reconstructive Surgery, accepted in 1994 and presented at the fall 1994 ASOPRS meeting in San Francisco, I noted (and illustrated) the almost universal finding of eyelash ptosis in the 17 new cases I described. The thesis was published in June of 19971McNab A.A. Floppy eyelid syndrome and obstructive sleep apnea.Ophthal Plast Reconstr Surg. 1997; 13: 98-114Crossref PubMed Scopus (126) Google Scholar and emphasized another common and important feature in patients with FES: obstructive sleep apnea. Having now personally observed and treated more than 50 patients with FES, I can attest that the sign of eyelash ptosis (with loss of eyelash parallelism) is present almost universally and is a useful indicator to the presence of underlying FES, even before the lids are palpated and everted.I was disappointed with the degree of thoroughness of Langford and Linberg’s literature review. They cite 16 papers on the subject of FES but my own review, completed in 1994, discovered an additional 17 papers, most published outside of the United States. It continues to grieve those of us who work and often publish outside North America to see how little regard is paid to our work by many American authors publishing in American journals. Ophthalmology’s editor has made efforts to “internationalize” the Journal and has reminded authors and reviewers to be more aware of material published in international venues.2Minckler D. Appreciating Ophthalmology’s international connection.Ophthalmology. 1995; 102 ([editorial]): 175-176Abstract Full Text PDF PubMed Scopus (3) Google Scholar The article “A New Physical Finding in Floppy Eyelid Syndrome” by Langford and Linberg (Ophthalmology 1998;105:165–9) rightly emphasizes the consistency with which eyelash ptosis is seen in this condition. To claim it as a “new” physical finding, however, is a little unfair to those who have previously described it as a feature of floppy eyelid syndrome (FES). The clinical feature described as “eyelash ptosis with loss of eyelash parallelism” is, I am sure, the same thing observed by other authors and described as lash ptosis, but it is more elegantly and completely described by Langford and Linberg. As the authors state, eyelash ptosis has been described in 8% of 113 cases found in their literature search. In my thesis for membership of the American Society of Ophthalmic Plastic and Reconstructive Surgery, accepted in 1994 and presented at the fall 1994 ASOPRS meeting in San Francisco, I noted (and illustrated) the almost universal finding of eyelash ptosis in the 17 new cases I described. The thesis was published in June of 19971McNab A.A. Floppy eyelid syndrome and obstructive sleep apnea.Ophthal Plast Reconstr Surg. 1997; 13: 98-114Crossref PubMed Scopus (126) Google Scholar and emphasized another common and important feature in patients with FES: obstructive sleep apnea. Having now personally observed and treated more than 50 patients with FES, I can attest that the sign of eyelash ptosis (with loss of eyelash parallelism) is present almost universally and is a useful indicator to the presence of underlying FES, even before the lids are palpated and everted. I was disappointed with the degree of thoroughness of Langford and Linberg’s literature review. They cite 16 papers on the subject of FES but my own review, completed in 1994, discovered an additional 17 papers, most published outside of the United States. It continues to grieve those of us who work and often publish outside North America to see how little regard is paid to our work by many American authors publishing in American journals. Ophthalmology’s editor has made efforts to “internationalize” the Journal and has reminded authors and reviewers to be more aware of material published in international venues.2Minckler D. Appreciating Ophthalmology’s international connection.Ophthalmology. 1995; 102 ([editorial]): 175-176Abstract Full Text PDF PubMed Scopus (3) Google Scholar