A 40 y.o. male woke up at 3 am with eye pain.

What do you think happened to his eye?

Our patient had a spontaneous luxation of the the globe caused by floppy eyelid syndrome. He had obstructive sleep apnea.

Luxation of the globe can happen spontaneously , voluntarily or traumatically. The equator of the globe protrudes anterior to the eyelid aperture, The orbicularis muscle contracts ,causing further anterior displacement and the globe is caught outside the eyelid aperture. This can occur spontaneously without conscious effort, voluntarily, with conscious effort, or secondary to trauma. Immediate reduction is warranted to prevent ischemia to the optic structures.

laxity of the upper lid in a patient with floppy eyelid syndrome

Floppy eyelid syndrome can be responsible for spontaneous globe luxation. Extensive eyelid laxity can be attributed to a decrease in elastin in the eyelid. This is known to be associated with obesity, males, obstructive sleep apnea, thyroid disease, Downs syndrome and keratoconus.

Our patient had a corneal lesion from drying of the cornea

Our patient received a COVID swab and by opening his eye widely reduced his own luxation.He had a corneal defect which had resolved when he was seen 6 days later.

Our patient following his covid swab

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Culbertson W, Ostler H. The floppy eyelid syndrome. Am J Ophthalmol. 1981;92568-575

Chambe J, Laib S, Hubbard J, Erhardt C. ruppert E, Schroder C, et al. Floppy eyelid syndrom is associated with obstructive sleep apnea: a prospective study on 127 patients. J Sleep Res. Oct. 11,2011.