Advancing Wavelike Epitheliopathy Secondary To Floppy Eyelid Syndrome: A Case Report

Published 2024 - 42nd Congress of the ESCRS

Reference: PO838 | Type: Free paper | DOI: 10.82333/431e-8x06

Authors: Alejandro Alcaide Costa* ¹ , Victor Manuel Charoenrook ¹

¹Centro de Oftalmología Barraquer,Barcelona,Spain

Purpose

Advancing wavelike epitheliopathy (AWE) is a chronic and recurrent disorder which is characterized by well-defined patches of irregular and coarse corneal epithelium. Some etiologies that have been proposed are ocular surgery history, contact lens wearing, topical medication toxicity and inflammatory disorders. However, floppy eyelid syndrome (FES) has not been well documented as such a consistent cause of limbal stem cell deficiency and associated corneal epitheliopathies. We present a case of FES as the most plausible cause of limbal stem cell deficiency and secondary AWE in a patient with no other relevant risk factors.

Setting

Department of Cornea and Ocular Surface, Barraquer Eye Center, Barcelona, Spain.

Methods

We present a case of a 73 year-old patient, who came to our center because of visual loss and foreign body sensation in his left and only one eye. He had been given a wide variety of treatment, mainly lubricants, with no improvement. Best corrected visual acuity (BCVA) was 0.45 in the first visit and ocular exam revealed irregular wavelike pattern of corneal epithelium in the upper two thirds involving the visual axis. Moreover, upper eyelid hyperlaxity could be observed. Schirmer test and meibography were normal and there was no history of topical medication. Therefore, corneal epitheliopathy secondary to limbal stem cell deficiency caused by FES was considered.

Results

Treatment for the eyelid hyperlaxity with artificial tears, topical corticosteroids with tapering off regimen and eye shield were prescribed. Polysomnography was carried out and revealed obstructive sleep apnea syndrome positive.

Three months later, the AWE had regressed to the superior hemicornea and six months later it had improved to nearly complete regression, with BCVA of 1.0, being his highest visual acuity registered to date. Follow up visits every 6-12 months were scheduled, with no relevant changes, neither in ocular surface aspect nor in BCVA.

Conclusions

FES is a common finding but it is frequently underdiagnosed and mistreated. Ocular surface alterations secondary to FES have been described, such as recurrent corneal erosion or superficial punctate keratitis but corneal epitheliopathies caused by limbal stem cell deficiency secondary to FES are not as well documented. They are usually associated with ocular surgery, contact lens abuse, topical medication toxicity and even underlying inflammatory disorders. A detailed history of patient’s habits, as well as a thorough eyelid examination, are fundamental when treating a patient with ocular surface and corneal pathology.