Diseases of the Eyelids

Eyelids are crucial to the health of the underlying eye. They provide coverage of the cornea and aid in the distribution and elimination of tears. Fortunately, most eyelid disorders are not vision‐threatening or life‐threatening; however, many cause irritating symptoms such as burning, foreign‐body sensation or pain. An exposed cornea may develop surface defects, scarring, abnormal blood vessels or even infection. Resulting symptoms include eye irritation, pain and loss of vision. Eyelid closure distributes tears over the surface of the eye and pumps them through the lacrimal puncta into the tear duct. Excessive tearing, or epiphora, may result from various eyelid disorders.

Several glands along the eyelid margin contribute to the makeup of the eye’s tear film. These glands can easily become inflamed, blocked or infected. Eyelid problems range from benign, self‐resolving irritations such as inflammation or infections to malignant, even metastatic tumors, as well as surgically treated structural problems, such as ectropion or entropion lids:

• Blepharitis, or eyelid inflammation, one of the most common problems, is characterized by red swollen eyelids with accumulation of debris along the eyelid margin. Malignant eyelid tumors may be associated with lash loss and erosion of normal eyelid structures. Recognition and diagnosis of these problems are crucial to their proper management. Warm compresses and antibiotics suffice for many conditions, while excision, cryotherapy or laser treatments are required for some.

• Ectropion Lid ‐ In the ectropion lid, the lower eyelid turns outward. This is often occurs as the eyelid stretches with age, drooping down and outward. Less often it may be caused by eyelid burns or skin disease. Ectropion lids may result in dry eyes, excessive tearing, redness, and sensitivity to light and wind. Surgery can restore the eyelid to its normal position.

• Entropion Lid ‐ In the entropion lid, the lower eyelid turns inward. Although this is usually the result of aging, it can be found at any age. The inward turning of the eyelid causes the eyelashes and skin to rub against the eyeball, making it red, irritated, and sensitive to light and wind. If not treated, this inward turning of the eyelid can cause an eye ulcer. Surgery is the usual treatment and can turn the eyelid outward to its normal position.

• Ptosis – Ptsosis is drooping eyelids. It is found in both children and adults, may affect one or both eyes, and can vary in its severity. It is usually caused by a poorly developed elevator muscle that opens the eyelid (in children) or by a separation of the same muscle in aging adults. Surgery is an effective treatment for this condition in most cases.

• Hordeolum ‐ A hordeolum, also known as a stye, is an acutely red and tender lump within the eyelid. The typical hordeolum occurs when the more outwardly located glands just behind the lash line become infected. Hordeola usually drain spontaneously after a week of treatments with warm compresses and topical antibiotics. Incision and drainage may be required for non resolving lesions. Some hordeolum, caused by infection of the meibomian gland, may evolve into chalazion.

• Chalazion ‐ Chalazia appear most commonly as chronic subcutaneous nodules within the eyelid. Initially, a chalazion may be red and tender like a stye before evolving into a non‐tender lump. Blepharitis is often associated with chalazia. A chalazion results when the meibomian gland becomes obstructed. The obstruction of the duct at the eyelid margin results in a release of the contents of the gland into the surrounding eye lid tissue. A nodule develops in the tissue of the eyelid. Chalazion can be medically treated and managed.