The 5 Most Common Ocular Manifestations of Obstructive Sleep Apnea

Christopher J. Lettieri, MD


October 02, 2013

In This Article

Editor's Note:
Obstructive sleep apnea (OSA) is associated with numerous comorbid conditions. In many, a causative relationship has either been well established or strongly associated. As the knowledge of sleep-disordered breathing and its consequences continues to grow, so does the list of associated or consequential conditions. The following is part 4 of a 5-part series exploring more recently identified consequences if OSA.


Several ophthalmologic conditions have been found to have a clear association with OSA. Similarly, OSA may present with several ocular manifestations. Simple and benign findings, such as drooping of the eyelids, are a common and early sign of sleepiness, whereas other sequelae may herald a more serious underlying condition.

It is important for optometrists, ophthalmologists, and primary care providers to be aware of these physical findings and unusual associations, because they may represent a potentially vision-threatening disorder. Routine screening for sleep-disordered breathing in these conditions is highly recommended.

Floppy Eyelid Syndrome

Floppy eyelid syndrome (FES) is the most common ocular disorder associated with OSA.[1] FES is characterized by papillary conjunctivitis and a rubbery, redundant upper eyelid tissue. Similar to OSA, FES is more prevalent in obese, middle-aged men. Of note, FES frequently presents unilaterally, affecting the eyelid on the side the patient most often sleeps on.

FES is observed in 2%-5% of patients with OSA. However, among patients with FES, the prevalence of OSA approaches 90%.[1,2] The association of OSA and FES was explored in a case/control study by Ezra and colleagues.[3] In this study, 102 patients with FES were compared with 102 matched controls. OSA was identified in 32 of 102 patients with FES (31.4%), compared with only 9 of 102 controls (8.8%).


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