Keratoconus, floppy eyelids and eye rubbing
One of you kindly sent me this patient to assess. She is an obese young female with reduced vision in the one eye.
She certainly does have keratoconus in the right eye, and as expected, aggressively rubs the right eye.
But have a look at her right eye…
Closer…
Closer…
Real close!
Note the right upper eyelid…something is going on.
Turns out, she has sleep apnoea and sleeps face down on her right elbow.
This is floppy eyelid syndrome, associated with eye rubbing, and a prime manifestation of nocturnal eye rubbing.
Note how easy it is to distract the upper eyelid.
So what did I do?
Treated her as a person, not as an eye doctor wielding my cross linking machine for the Keratoconus. I sent her for sleep apnoea workup, sleep studies, consideration for bariatric surgery, and ways to reduce eye rubbing.
She is at risk of rupture so I will follow her closely.
When you treat the patient as a whole, treatment is more enjoyable and more effective.
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Dear All,
This is a followup from the case above.
One photo shows how this young lady sleeps, head nestled in cubital fossa of the right arm.
The other is what I refer to as type 3 eye rubbing, an aggressive palm rubbing of the eye and eyelid.
When you see this in action, it all makes sense.