A 39-year-old woman with obesity presented to an ophthalmology clinic with a 6-week history of a foreign-body sensation and tearing in both eyes. Symptoms were worse upon awakening. She also reported daytime fatigue, snoring, and difficulty sleeping at night. Ophthalmologic examination and findings with attempted closure of both eyes are shown. What is the most appropriate next step?
一名39岁肥胖女性因双眼异物感及流泪6周就诊于眼科门诊。症状在晨起时尤为明显。她还诉日间疲劳、打鼾及夜间入睡困难。眼科检查及尝试闭眼时的表现如图所示。下一步最恰当的诊疗措施是什么？
A. Blepharoplasty眼睑成形术
B. Computed tomography of the chest to look for a superior sulcus tumor胸部CT扫描以排查眶上沟肿瘤
C. Ice pack test冰袋试验
D. Referral for a sleep study转诊进行睡眠呼吸监测
E. Topical antimicrobials局部使用抗菌药物
答案解析：
检查发现：双侧眼睑上睑外翻，结膜充血，闭眼时眼睑无法完全贴合。嘱患者向下注视并手动牵拉上睑时，可见明显松弛，上睑可完全外翻。最终诊断为松软眼睑综合征（floppy eyelid syndrome）。该综合征以上睑过度松弛为特征，可导致眼睑位置异常及眼表慢性刺激，常与阻塞性睡眠呼吸暂停（OSA）相关。
患者随后被转诊接受多导睡眠监测，结果显示为中度阻塞性睡眠呼吸暂停。治疗方面，患者开始接受夜间持续气道正压通气（CPAP）、眼部润滑剂，并在睡眠时使用眼罩保护。随访发现其眼睑改变明显改善。
正确答案：D
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