Eyelid laxity in obese patients without eye symptoms

Purpose. The floppy eyelid syndrome is characterized by an easily everted upper eyelid associated with chronic papillary conjunctivitis and irritative symptoms. This disorder typically affects overweight subjects. The aim of this study was to investigate the amount of eyelid laxity in obese patients who are free from eye symptoms. Methods. Twenty obese patients (body mass index > 30), 14 females and 6 males, ages from 22 to 66 (mean = 40) years and 19 normal subjects, 7 females and 12 males, ages from 19 to 62 (mean = 33.8) years were examined by the same ophthalmologist. In order to quantify eyelid laxity three tests were performed in each individual: a) the skin in the area of the lateral canthus was pulled laterally and the amount of separation between the lateral canthus and the globe was recorded, b) the lower and upper eyelid were pulled forward and the amount of separation between the lid margin and the globe was measured and c) the lower and upper eyelid were respectively pulled down and up and the amount of displacement of the eyelid margin (inferior for the lower lid and superior for the upper lid) was measured. All measurements were done with a standard millimeter ruler. Results. Unpaired t tests showed that the mean displacement of the lateral canthus, the mean lower and upper eyelid distraction from the globe and the mean superior displacement of the upper eyelid margin, were significantly greater for the obese patients. Conclusions. Obese patients tend to have less eyelid tension. Some obese subjects can display extreme degrees of eyelid laxity without any eye symptoms. Our results suggest that the etiology of the floppy eyelid syndrome can not be related only to the increase of lid laxity.