Purpose
Lax eyelid syndrome (LES) is defined as the association of distensible “floppy” eyelids and chronic papillary conjunctivitis. LES is also found in patients with obstructive sleep apnea (OSA) who have systemic elevation of inflammatory markers, including matrix metalloproteinases (MMP). Locally elevated MMP levels have also been demonstrated co-localized with elastin loss in eyelids of patients with LES, accounting for their “floppiness.” The purpose of this study was to investigate tear film MMP levels and determine their association with eyelid laxity and OSA. We also evaluated 3 previous grading systems to determine the severity of lid laxity and introduced a new “laxometer” device.
Methods
Thirty-seven subjects underwent bilateral eyelid laxity assessments prior to polysomnography testing. OSA severity was graded using the apnea hypopnea index (AHI). The degree of eyelid laxity was determined using three published methods and a newly proposed “laxometer” method. Commercially available InflammaDry® kits were used to determine the presence of MMP-9 in the tear film.
Results
There was a significant elevation in tear MMP-9 levels in patients with LES compared to controls (p < .05). Of the 37 total patients enrolled in this study, 2 patients (5.4%)
did not have sleep study results. Thirty-two of the remaining 35 patients (91.4%) were determined to have OSA (AHI > 5). In this sample, there was no meaningful association between OSA and MMP-9 (p = .12). Although there were positive associations between OSA severity, laxometer measurements, and previously established grading methods, none achieved statistical significance (all p > .05).
Conclusions
There was an elevation of MMP-9 in tears of patients with LES. Elevated tear MMP-9 was also not associated with OSA. Although there is some evidence to support the association of eyelid laxity and OSA, the most accurate and reliable method for grading eyelid laxity remains unclear.
My eight year old daughter was terrified to go to the eye doctor for fear of her eyes being dilated. The doctor was SO KID friendly! He immediately made her comfortable by engaging her in conversation. It was a geat experience.
Dr. Garbus spent an amazing amount of time to solve my very complicated visual problems. Over the years he has continually achieved results beyond what others felt possible. He is always up to date on the latest science. He is great!
Family Vision Care Valencia makes it so easy. Staff is knows what they are doing and Dr. Garbus is thorough and kept me well informed during the exam.
I have been coming to Family Vision Center for almost 20 years. Dr. Garbus has been able to help my vision when other doctors could not. Now my kids see him as well. I highly recommend this office!
The Doctor is very good. I felt on this visit he seemed rushed. I had questions to ask him but he was already with another patient. I still do not know if my eyes are the same , worse, or better.
All the staff is friendly, helpful and knowledgeable, and has been for all the years I have been going there.
According to the American Optometric Association, approximately 80% of what a child learns in school is acquired through vision, and vision problems can significantly impact academic performance. As a developmental optometrist, has treated many students who struggle to learn how to read due to vision problems. In this blog, we will explore how vision therapy […]
Bloodshot eyes can be alarming, but they are not always a cause for concern. In this blog, we will discuss the common causes of bloodshot eyes, how to treat them, and when to seek medical attention. We will also provide some helpful tips for preventing bloodshot eyes in the future. Understanding Subconjunctival Hemorrhage A subconjunctival […]
As parents and teachers, we often assume that a child's ability to read the letter chart accurately is the only indicator of good eyesight. However, there is much more to vision than just acuity (identifying the letters on an eye chart). It is critical for parents to understand that a vision screening is only identifying […]
