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.
Vision therapy is well worth the response, time and effort. Our Son had a hard time focusing and writing neatly. After vision therapy Seth could complete a task in half the time if previously took. His abilities to focus improved greatly and so did his handwriting.
Also, he was better at listening. As a parent, we wanted learning to be fun for our Son, and vision therapy made this possible.
Vision Therapy is well worth the expense, time and effort. Our son had a hard time focusing handwriting neatly. After vision therapy Seth could complete a task in half the time it previously took his abilities to focus and improved greatly and so did his handwriting.
Also, he was better at listening. As a parent you wanted learning to be fun for our son and vision therapy made this possible.
Vision Therapy has given or son the tools he needs to be able to scan and read the written word more effectively and efficiently.
He love working with John and these working sessions give him the motivation to gladly work on his homework assignments.
It amazed us to see the difference in the tracking of his eyes and along a line of it's from the beginning to the end of the treatment.
Dr. McBryar , Kristen and John are all marvelous and we would recommend them to anyone I only wish that we would have found them sooner!
Prior to coming to the institute for vision development my son complained of daily headaches. Therapy has eliminated his headaches completely. I love knowing my son is able to learn pain-free for the rest of his life because of the work that has been done over just a few weeks in this office. He he absolutely loved coming that didn't even feel like going to a doctor or therapy. We are grateful for the relief he was able to find by coming here.
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Seems much less frustrated with life
Reads non-stop and fast
Spelling abilities have been hugely improved
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When we first came to the practice, my son did not have huge issues, but lots of small ones- trouble with reading, sports (hitting the baseball consistently), coordination, etc- that were not easily detectable,but when put together presented issues. The staff here were all very professional and loving towards him. While I was concerned in the reading, my son was concerned with the athletic side. Seeing improvement night off the bat gave him confidence that i have nor seen in him and made him want to not only Come to therapy, but also made him want to work hard. He has surpassed his grade level and above in reading and hit his first home run this year! Thank you!!!
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Are you tired of dealing with eyelid inflammation? Well, there's good news for you! Hypochlorous acid, a natural bactericidal compound, has been clinically shown to help fight against various eyelid conditions such as blepharitis, and it's even effective at preventing the development of styes and other eyelid infections. In this blog, we'll be exploring the […]
