September 2016
Volume 57, Issue 12
Open Access
ARVO Annual Meeting Abstract  |   September 2016
Lax Eyelid Syndrome, Obstructive Sleep Apnea Syndrome (OSAS), and Ocular Surface Inflammation
Author Affiliations & Notes
  • Mackenzie Becker
    Ophthalmology, Loyola University Medical Center, Maywood, Illinois, United States
  • Clayton Kirk
    Ophthalmology, Loyola University Medical Center, Maywood, Illinois, United States
  • Ramsudha Narala
    Kresge, Detroit, Michigan, United States
  • Sunita Kumar
    Ophthalmology, Loyola University Medical Center, Maywood, Illinois, United States
  • William Adams
    Ophthalmology, Loyola University Medical Center, Maywood, Illinois, United States
  • Charles S Bouchard
    Ophthalmology, Loyola University Medical Center, Maywood, Illinois, United States
  • Footnotes
    Commercial Relationships   Mackenzie Becker, None; Clayton Kirk, None; Ramsudha Narala, None; Sunita Kumar, None; William Adams, None; Charles Bouchard, None
  • Footnotes
    Support  Richard A. Perritt Charitable Foundation
Investigative Ophthalmology & Visual Science September 2016, Vol.57, 3888. doi:
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      Mackenzie Becker, Clayton Kirk, Ramsudha Narala, Sunita Kumar, William Adams, Charles S Bouchard; Lax Eyelid Syndrome, Obstructive Sleep Apnea Syndrome (OSAS), and Ocular Surface Inflammation. Invest. Ophthalmol. Vis. Sci. 2016;57(12):3888.

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      © ARVO (1962-2015); The Authors (2016-present)

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Abstract

Purpose : Lax eyelid syndrome (LES) describes the association of distensible “floppy” eyelids and chronic papillary conjunctivitis that has a well-known association with OSAS. Eyelid histopathology suggests that LES may result from overexpression of matrix metalloproteinase 9 (MMP-9) related elastin degradation. However, the relationship between the degree of eyelid laxity and OSAS and elucidation of MMP-9 levels in LES subjects has not been clearly demonstrated. The purpose of this study therefore was: 1) establish the prevalence and degree of eyelid laxity in patients with newly diagnosed OSA; 2) to evaluate the presence of MMP-9 in the tear film of patients with LES; and 3) to compare the current LES grading systems with a newly designed “laxometer."

Methods : Following OSAS evaluation by polysomnography, subjects were referred for eyelid laxity determination and an MMP tear assay. Measurements of the degree of eyelid laxity were determined for each eye using the following four methods: 1) degree of tarsal conjunctiva exposure; 2) ease of upper eyelid eversion; 3) degree of medial canthal tendon laxity; and 4) distensability of the laxometer. The MMP-9 tear film assay was conducted using a commercially available assay.

Results : There was a small but non-significant positive association between laxometer measurement and duration of eyelid eversion (τ = 0.16, p = .29). Conversely, there was a small but non-significant negative association between laxometer measurement and duration of eyelid eversion (τ = -0.19, p = .25). A nonparametric Kreskas-Wallis test was used to assess whether eyelid elasticity varied as a function of sleep apnea severity. Although the study was unpowered for statistical significance, a positive trend was found between degree of sleep apnea and eyelid laxity determined by laxometer measurements. For the MMP-9 levels, 14 of 16 eyes (89%) with LES had a positive MMP-9 assay (p< .001).

Conclusions : Although our current study sample is small, the laxometer data suggests an association between the severity of LES and the severity of OSAS that may have clinical relevance. The findings of elevated MMP-9 supports a notion that MMP plays a role in elastin degradation that may be associated with chronic conjunctivitis and reactive ocular surface typically found in patients with LES. We are currently recruiting additional patients to better assess the relationship between lid laxity and OSAS.

This is an abstract that was submitted for the 2016 ARVO Annual Meeting, held in Seattle, Wash., May 1-5, 2016.

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