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Charles S Bouchard, Sarah Maki, Nidhi Undevia, Bruce Gaynes, Ron Price, Dan Valdez; The Association of Systemic and Ocular Disease and the Under Diagnosis of Floppy Eyelid Syndrome in Patients with Obstructive Sleep Apnea. Invest. Ophthalmol. Vis. Sci. 2014;55(13):1465.
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© ARVO (1962-2015); The Authors (2016-present)
Floppy eyelid syndrome (FES), a subset of lax eyelid conditions, is characterized by an extreme laxity of the (upper) eyelids causing eversion upon minimal mechanical manipulation. FES is associated with chronic papillary conjunctivitis, obesity and male gender. The pathophysiology of FES is unknown, but an increase in matrix metalloproteinases, a decrease in elastin fibers in the eyelid, and nonspecific signs of chronic ocular surface inflammation have been demonstrated. FES is also known to be associated with other ocular and systemic disease including obstructive sleep apnea-hypopnia syndrome (OSAHS). We conducted this study to determine the association of OSAHS with various ocular and systemic diseases.
A data mining study using ICD-9 codes for ocular and systemic diseases was performed using the electronic database of 562,585 patients seen at the Loyola University Medical Center (LUMC) between 2008 and 2013. The resultant data was compiled using odds ratios to compare the incidence of each ocular and systemic disease in patients with OSAHS (327.23) compared to the incidence of the disease in the general population.
Of the total 562,585 patients, 11,975 had a diagnosis of OSAHS (327.23). The strongest correlation of ocular disease in the patients with OSAHS was FES with an odds ratios (OR) for "other disorders of the eyelid" and "unspecified inflammation of the eyelid" of 4.97 (p< 0. 0001) and 6.51 (p< 0.0001) respectively with a combined OR of 5.61 (p<0.001). This was followed by tear film insufficiency (OR 4.557, p<0.001), blepharitis (OR 4.214, p<0.001), rosacea conjunctivitis (OR 4.148, p<0.001), and keratoconus (OR 3.556, p<0.001). Systemic associations of OSAHS include obesity with an odds ratio of 20.21 (p<0.001), hypertension (OR 9.391, p<0.001), diabetes mellitus type 2 (OR 8.115, p<0.001), diabetes mellitus type 1 (OR 5.194, p<0.001), and rosacea (OR 3.182, p<0.001).
There is a positive association between OSAHS and the ocular diseases of: FES, dry eye, rosacea conjunctivitis and keratoconus. Systemic associations include: obesity, hypertension, diabetes mellitus type 1, rosacea, and diabetes mellitus type 2. Although the association between FES and OSAHS was significant, our data suggest it is under diagnosed at this tertiary care medical center when compared to control values in the literature.
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