Floppy Eyelid Associated With Down Syndrome

Abstract

Eyelid laxity due to Down Syndrome may be better classified under the rubric of lax eyelid conditions.

• Down syndrome
• Ectropion
• eyelid laxity
• floppy eyelid syndrome

In his article entitled “Management of Floppy Eyelid Associated With Down's Syndrome: A Case Report",1 the author describes the eyelid laxity in his patient with Down’s syndrome as floppy eyelid syndrome (FES) and subsequently elaborates at length on the theories suggested for the pathogenesis of floppy eyelid syndrome.

As correctly alluded to in the article, It is unlikely that frequent eye rubbing or preferential sleeping in a 2-year-old boy are at play here, neither was obstructive sleep apnea demonstrated, and the probable etiologic factor may be related to a tarsal pathology, canthal tendon laxity and/or muscle hypotonia that frequently plague patients with Down’s syndrome, and is not due to the mechanical factors typical of FES.

Floppy eyelid syndrome is a specific term that is used to describe predominantly obese males with asymmetrical lax rubbery eyelids and papillary conjunctivitis that is frequently associated with eye rubbing, preferential sleeping on the affected side, and occasionally sleep apnea syndrome. It is now subclassified under the broader term lax eyelid conditions (LEC), which is defined as laxity of the eyelid resulting from any cause at any age or sex. Therefore, I think the author's unusual case should be classified together with FES under the umbrella of the all-encompassing term LEC, and not as a case of FES.

Hatem A Tawfik, MD

Cairo, Egypt