Floppy Eyelid Syndrome

I've had hundreds of conversations over the years with FES patients looking for a solution that will protect their eyes while they sleep.

They come in many shapes and forms, but the "classic" case is the 50+ male with lax eyelids who sleeps on his side or stomach, and his corneas are anything from irritated to ulcerated from rubbing on the pillowcase. Usually, by the time they get to me, they've tried ointments, maybe tape, maybe a sleep mask, and nothing's working.

Today's tip is all about my experiences of what tools work (or don't) and why.

Tape? Maybe.

A commonly recurring phone call at the DryEyeShop starts like this: "My doctor told me to just tape my lids shut. But...."

Even the most compliant patients may find taping impractical for a variety of reasons, such as:

• Deep set eyes can be very difficult to tape securely. 
• Prominent eyes may experience trauma in spite of taping. 
• Ointment users find the greasy goop interferes with the adhesive - in particular, if they get up in the night and lift the tape to see, it won't stick back down again.
• The more elderly the patient, the less practical tape is from a safety standpoint (risk of falls) and skin sensitivity.

For some patients, our EyeLocc strips may be a good alternative. They are easier to apply, easier on the skin and easy to lift and replace when getting up in the night.

Mask? Possibly, but it can backfire.

For some patients, a sleep mask may be enough protection, but for others the remedy can definitely be worse than the problem. Most sleep masks are soft and will easily be pressed down on the eyes, causing the same trauma as the pillowcase or worse.

One possible exception, but probably only suitable for patients with deep set eyes, is Dream Essentials' Escape sleep mask. This one is very structured, has cavities over the eye areas and a secure strap. I have some clients who use it successfully - but others who tried it and found it moved in the night and their eyes rubbed on the padding! So this is never a first choice for me.

Moisture goggle? Maybe

Here are some key considerations for trying a protective goggle for FES:

• Will it stay on? Many of you are familiar with the various dry eye goggles from Eye Eco. They are excellent for dry eye patients, but... they have a slippery strap. For the FES patient, a secure strap is essential.
• Is it rigid enough to protect the eyes? If it's too flexible, then a patient who presses into the pillow will find it gets squashed right down onto their eyes. Eye Eco's EyeSeals (thermoplastic shield) is a favorite for men with dry eye and usually my first recommendation... except for FES. I have some stomach sleepers who use it successfully but many more who found it gets pressed down too easily.
• Is it comfortable enough to sleep in? That's the toughest thing to achieve: Secure, rigid, AND comfortable? Yet comfort is a necessity if you want to get a decent night's sleep. For most patients, that rules out the swim goggles.
• Will it leave marks? Nobody wants big rings around their eyes in the morning. Yet anything you wear while sleeping on your face may cause indentations. Once again, swim goggles are the very worst in that regard.

Post LASIK goggle: Yes!

The only product I feel consistently meets most of those needs is the Post LASIK Goggle (below). It's not perfect, and it's not always quite tall enough for people with extra large orbits, but it's worked for more people than anything else I know. It's also inexpensive. Post LASIK shield can do a similar job, more cheaply, but... a lot less comfortably.

NITEYE? Yes but... expensive, awkward

The NITEYE bubble bandages are one of my favorite tools for people with a problem affecting only one eye, e.g. Bell's palsy.

For two eyes... they're disposable, very costly, and awkward to apply if you're using two every night. They are however excellent protection for FES:

• Bubble is rigid enough to take a beating (compared to Ortolux which is much softer) and vaults high over the eye
• Adhesive is secure without being overly irritating

So, for some patients, especially those who cannot wear goggles but can tolerate the cost, this is another option.

My favorite products for FES

LASIK goggle

LASIK shield

EyeLocc occlusion dressings

NITEYE bubble eye bandages

Got a challenging FES patient?

Call us, or ask your patient to call us for a free consultation, so we can help find the right solution for them.

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