A thorough ocular history should be obtained to attempt to uncover the presence of chronic conjunctivitis or uveitis, or a past or present history of cicatricial diseases such as ocular pemphigoid or Stevens-Johnson syndrome. A history of morning ocular irritation and spontaneous eyelid eversion during sleep, particularly in an obese male, should lead to careful examination of the conjunctiva for papillary conjunctivitis, and of the tarsus for possible floppy eyelid syndrome.