Eyelid Laxity, Obesity, and Obstructive Sleep Apnea in Keratoconus

Purpose: The association between floppy eyelid syndrome and keratoconus (KCN) has been well established, but the converse relationship has not yet been examined and is the objective of this study. The study also investigates the prevalence of obesity and obstructive sleep apnea (OSA) in KCN patients.Methods: A prospective case-control study of KCN patients with age-, sex-, race-, and body mass index-matched controls was conducted at the Ross Eye Institute, Buffalo, NY. Fifteen patients were enrolled in each group. Extensive eyelid laxity measurements were performed on both groups. Complete medical/ophthalmic history and Epworth Sleepiness Scales were completed on 50 KCN patients and were compared with the normal population.Results: Increased eyelid measurements of the vertical lid pull, lower lid pull, medial canthal tendon distraction, and palpebral width were found in the KCN group compared with the matched control group (P = 0.001, 0.005, 0.04, and 0.01, respectively), and a more rubbery tarsus (P = 0.03), increased corneal diameter (P = 0.02), and increased exophthalmometry measurements (P = 0.01) were also found. The prevalence of OSA (24%, 14/50) and obesity (52%, 26/50) were higher in the KCN patients versus the normal population.Conclusions: KCN patients have increased laxity to their eyelids, along with a more rubbery tarsus, which may be along the spectrum of floppy eyelid syndrome. KCN patients had a high prevalence of OSA and obesity. The high prevalence of OSA in KCN patients is an important association that carries an increased risk of death from any cause and stroke.