Common Eyelid problems related to dry eye disease, Part 5: Floppy Eyelids!

When eyelids turn in the wrong direction: Floppy lids, malocclusion and snoring – a bad combination.

How can snoring be related to dry eye? - As a dry eye specialist, I can say there is a common connection. It turns out that the elastin (the tissue that gives the "elastic snap") to your voice box/airway area is the same type of elastin that is in your eyelids. If that elastin is weak, then lids lose their "snap" and can stretch out - making the lids tend to lose contact with each other when you relax (as in sleep) and they can pull away with gravity, exposing your eyes to room air (or to the ""blow-by" from a CPAP machine). Fans, Air Conditioning, or the rush of air from CPAP, (CPAP stands for Continuous Positive Airway Pressure, which is a machine that uses mild air pressure to keep breathing airways open while you sleep.) -

Image from: https://www.nhlbi.nih.gov/health/cpap illustrating (one of many options) CPAP device in use..

Image from: https://www.nhlbi.nih.gov/health/cpap

 can cause increased evaporation of the tears that are exposed - and then your eyes get drier. When an eye doctor asks if you snore, they are trying to see if you might have Obstructive Sleep Apnea.

Below from the Mayo Clinic: https://www.mayoclinic.org/diseases-conditions/sleep-apnea/symptoms-causes/syc-20377631

“Obstructive sleep apnea

Above taken from the Mayo Clinic: https://www.mayoclinic.org/diseases-conditions/sleep-apnea/symptoms-causes/syc-20377631

“Enlarged image

Obstructive sleep apnea

This type of sleep apnea happens when the muscles in the back of the throat relax. These muscles support the soft palate, the triangular piece of tissue hanging from the soft palate called the uvula, the tonsils, the side walls of the throat and the tongue.

When the muscles relax, your airway narrows or closes as you breathe in. You can't get enough air, which can lower the oxygen level in your blood. Your brain senses that you can't breathe, and briefly wakes you so that you can reopen your airway. This awakening is usually so brief that you don't remember it.

You might snort, choke or gasp. This pattern can repeat itself 5 to 30 times or more each hour, all night. This makes it hard to reach the deep, restful phases of sleep.” Taken from the Mayo Clinic: https://www.mayoclinic.org/diseases-conditions/sleep-apnea/symptoms-causes/syc-20377631

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Having symptoms of drier eyes on waking can be related to loose or "Floppy" lids (as well as to sleeping with normal lids that don’t close all the way when sleeping – see my earlier post on “Mom’s eyes”  in the link below). When eyelids are “too floppy” the eyelids can roll over, (or become an “outtie” – similar to the discussion on ectropion) or can “mal-occlude” – where they don’t come together well enough (and the upper lid may slide over the lower lid, creating a gap that doesn’t wet well and may result in the lashes irritating the underside of the upper lid). To determine if this may be the case, doctors need to look under the lids to test how “floppy” they are and to observe the moist membrane (conjunctiva) lining the lids (giving further clues about your eye condition).

If you snore (or suspect you snore - a spouse or significant other can help confirm it), and you are found to have floppy lids, then the "Floppy Eyelid Syndrome" seems likely related, and the doctor will commonly recommend you check with your Primary Care Physician about getting a "Sleep Study." During a sleep study, the staff will be looking for sleep apnea (described above - the condition where your airway blocks mid-snore, and you can go lengths of time not breathing). Sleep apnea has been linked to early death (heart attacks, strokes, etc.) and may contribute to ever-weakening elastin - making dry eyes worse and your life in general - quite miserable - if not shorter than it would otherwise be. Get a sleep study if your doctor recommends it (and wear the devices prescribed - like CPAP, as they can save your life). Sleep goggles, Press N Seal or Sleep Tite Sleep Rite adhesive stickers can help, as can humidifying the air in your CPAP machine, humidifying your room air and making more and better tears as I outline in earlier posts (like the “Mom’s or Dad’s eyes” post here: https://www.eyethera.com/blog/do-you-have-moms-or-dads-eyes

When lids are too “Floppy,” surgical tightening is sometimes indicated, though the above recommendations are frequently sufficient to “work-around” the problem.

To schedule an appointment with Dr. Jaccoma, call Excellent Vision at either of these two dry eye offices:

(1) 155 Griffin Rd, Portsmouth, NH 03801 (603) 574-2020

(2) 3 Woodland Rd, STE 112 Stoneham, MA 02180 (near Boston) (781) 321-6463