Floppy eyelid syndrome: a diagnostic dilemma.

BACKGROUND: Floppy eyelid syndrome may be the underlining cause of papillary keratoconjunctivitis. Patients initially report a nonspecific irritation, redness, or a foreign body sensation. METHODS: As a result of its vague presentation, floppy eyelid syndrome is frequently misdiagnosed. A careful slit-lamp evaluation and a complete history aids in the diagnosis. CONCLUSIONS: The most distinctive feature of floppy eye syndrome is a pliant upper tarsus that is easily everted without excess manipulation. Histopathology has attributed the laxity of the lid to a decreased amount of elastin within the tarsus. Treatment includes prevention of the upper lid from everting during sleep or surgical procedures such as horizontal eyelid shortening. Our case report illustrates a patient with a classic case of floppy eyelid syndrome.

Adult onset foveomacular vitelliform dystrophy: a case report.

BACKGROUND: Pattern dystrophies of the retinal pigment epithelium, an arrangement of a pattern of dots, lines, or branches, are infrequent fundus abnormalities. Adult onset foveomacular vitelliform dystrophy (AOFVD) is considered a subtype of pattern dystrophy. Onset occurs during middle age, with an accumulation of yellow-gray macular deposits in the deeper retinal layers. Typically electro-oculograms are mildly subnormal or normal. Genetic studies suggest an autosomal dominant inheritance with variable penetrance. CASE REPORT: A case of a 56-year-old Hispanic women with a 1-month onset of "wavy moving vision" in both eyes is presented. Previous ocular and family history were unremarkable. Ophthalmoscopic examination revealed yellow circumscribed subretinal lesions of one-third to one-half disk diameter in the foveal centers of both eyes. Fluorescein angiography revealed a circumscribed area of mottled hyperfluorescence surrounding a central hypofluorescent spot. The patient was diagnosed with AOFVD. Examination of the patient's children revealed retinal pigment epithelial disturbances in the two oldest daughters, consistent with pattern dystrophies. CONCLUSION: Our investigation supports an autosomal dominant inheritance pattern, as seen on pedigree. The presence of different pattern dystrophies within the same family suggests a common etiologic continuum.