KEY POINTS
In patients with chronic obstructive sleep apnea (OSA), floppy eyelid syndrome is thought to be caused by mechanical trauma to the eyelids during sleep. It can be associated with many eyelid and corneal pathologic conditions, ranging from dry eyes to corneal ulceration and infection.
Glaucoma, ischemic optic neuropathy, papilledema, keratoconus, and retinal diseases are more prevalent in patients with OSA than in those without OSA.
Glaucoma is a slowly progressive degeneration of the optic nerve that does not cause symptoms until late in the disease process; thus, patients should be screened regularly for signs of glaucoma.
Ischemic optic neuropathy is an ischemic injury to the optic nerve that presents as sudden vision loss in one eye. Permanent vision loss can also occur in the fellow eye.
Papilledema is bilateral swelling of the optic nerves due to increased intracranial pressure.
Keratoconus is a bilateral progressive thinning of the cornea. It causes irregular astigmatism and can cause vision loss if severe. Keratoconus may have an association with floppy eyelid syndrome.
Retinal diseases, such as central serous chorioretinopathy or macular edema, can cause vision loss if severe and untreated. However, patients with OSA may respond poorly to anti-VEGF therapy for diabetic macular edema or wet macular degeneration.