Eyelid Disorders | Definition and Patient Education
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Eyelid Disorders

Overview

Your eyelids protect your eyes. They keep out foreign objects such as dust and sand. The act of blinking also keeps your eyes moist. Occasional fluttering of one eyelid is normal. Eyelid disorders can cause eyelid:

  • drooping
  • twitching
  • inflammation
  • paralysis
  • growths

Eyelid disorders involving inflammation

Blepharitis

Blepharitis is inflammation of the eyelids. Oil and bacteria coat the edge of the eyelid, near the base of the eyelashes. It can cause:

  • itching
  • stinging
  • burning
  • crustiness
  • redness

Blepharitis can often lead to a stye or a chalazion. You can treat blepharitis by applying warm compresses, cleaning your eyelids with a moist washcloth and baby shampoo, and applying antibiotic ointment.

Stye

A stye, or hordeolum, is a red, sensitive bump that appears on the edge of the eyelid. A bacterial infection of an oil gland, hair follicle, or sweat gland causes it. Styes usually recede without treatment over time. Applying warm, moist compresses several times per day can help it heal faster. If you have a stye that doesn’t recede within one to two weeks, you may need to take antibiotics.

Chalazion

A chalazion is a lump on the eyelid due to obstruction and inflammation of an oil gland. Some chalazions heal without treatment, but applying a hot compress will speed the healing process. You may need to take medication for it or have surgery to remove it. If a chalazion regrows in the same place, you should see your doctor. They can rule out a cancerous growth.

Meibomianitis

Meibomianitis, or posterior blepharitis, occurs when your eye’s oil glands at the base of the eyelashes become clogged. The eyelid thickens and may become crusty. Treatment for meibomianitis is the same as it is for blepharitis.

Lacrimal duct obstruction

The tiny hole at the inner corner of each eye leads to the lacrimal duct, which drains tears from your eye into your nose. When the duct becomes blocked, it can become inflamed or infected. The area will swell and may discharge pus. Common symptoms include:

  • irritation
  • itching
  • tearing
  • stinging
  • burning

Many obstructions clear spontaneously. Hot compresses speed the healing process. The area may also be massaged to help clear the blockage. You can take topical and oral antibiotics to treat the infection. If other treatments don’t work, surgery may be an option as a last resort.

Eyelid disorders involving lesions

Seborrheic keratosis

Seborrheic keratosis is a condition that causes oily, pigmented lesions that look like they’re stuck to the skin. They can occur anywhere on the skin, including the eyelids. They’re common in older adults, and your doctor can remove them surgically.

Actinic keratosis

Actinic keratosis appears as a patch of skin that’s:

  • flat
  • white
  • flaky
  • scaly

It can be a precursor to carcinoma.

Hidrocystoma

A hidrocystoma is a clear cyst that appears near the edge of your eyelid. The usual cause is a blockage of sweat glands. Your doctor can remove it surgically if it interferes with vision or causes pain.

Molluscum contagiosum

This condition causes small, waxy nodules. It’s due to a viral infection. It occurs in people who have compromised immune systems. The nodules can cause inflammation of hair follicles if they occur near an eyelash. Your doctor can remove them by performing surgery or freezing them, but they often clear up without treatment as the viral infection subsides.

Nevus

Nevi are small lesions that people are born with. People more commonly call them moles, birthmarks, or beauty marks. They can be flat or elevated, and they may or may not be pigmented. They usually aren’t precancerous. If one changes in appearance or size and becomes irregular in color or shape, your doctor should evaluate it for melanoma.

Xanthelasma

A xanthelasma is a soft, yellowish patch that can appear below the lower fold of the eyelid. Genetic factors or high cholesterol can cause it to occur. Your doctor can remove it surgically or by using a carbon dioxide laser.

Mechanical disorders of the eyelid

Blepharospasm

A blepharospasm is an abnormal, involuntary spasm of the eyelid muscle. It can appear as repetitive blinking, twitching, or fluttering. It’s different than non-pathological eyelid fluttering, which doesn’t affect the rest of your face. It can affect anyone, especially during times of sleep deprivation or stress.

The types of blepharospasm include:

Benign essential blepharospasm (BEB)

BEB occurs on both sides of the face. It’s a form of dystonia, which is a disorder that causes involuntary muscle contractions due to malfunctioning of the basal ganglia. BEB develops slowly, and some people have difficulty keeping their eyes open or are sensitive to light. Symptoms usually occur during the day and cease during sleep.

As the condition worsens, the spasms grow more frequent and intense, often forcing the eyes closed for periods. This can cause people with severe BEB to become functionally blind, although they have nothing wrong with their eyes. BEB occurs in men and women, but it most commonly occurs among older women.

Surgery can sometimes stop the muscle spasms, but this will cause permanent damage to the eyelid. Some medications work, including injections of botulinum toxin to relax or paralyze the muscles that have the spasms.

Hemifacial blepharospasm

This form of blepharospasm occurs on only one side of the face, and irritation of nerves in the face is usually the cause. Sometimes, tumors can cause blepharospasms. If you have facial spasms on one side of your face, you should get a brain MRI.

Blepharoptosis

Blepharoptosis, or ptosis, occurs when the upper eyelid droops. If the eyelid droops far enough, it can block your pupil, causing partial blindness. Ptosis has a variety of possible causes, including:

Congenital ptosis

Developmental problems of the levator, the muscle that lifts the upper eyelid, can cause congenital ptosis. A baby can be born with this type of ptosis. The condition usually affects one eye. If the eyelid droops low enough to obscure the field of vision, your child’s doctor will need to perform surgery to correct the ptosis and clear their vision. Otherwise, your child may develop lazy eye or permanent vision loss.

Aponeurotic ptosis

Ptosis that isn’t congenital is usually the result of aging. The long-term effects of gravity or repetitive opening of the eyelids, such as when changing contact lenses, stretch the connective tissues in the eye that attach to the levator. Both eyelids are usually affected, although one will often droop lower than the other. Treatment for this condition involves surgery.

Myasthenia gravis

Ptosis can be one of the early symptoms of myasthenia gravis, which is a rare disease that causes progressive muscle weakness in the face and elsewhere in the body. You should seek immediate attention for this condition.

Other causes of ptosis

Other medical conditions that affect the nerves or muscles can cause ptosis, including:

  • congenital muscle diseases
  • a stroke
  • a brain tumor
  • a brain aneurysm
  • nerve damage from uncontrolled diabetes
  • an infection of the eyelid
  • trauma to the eyelid

Coloboma

A coloboma is missing piece of eye tissue. This appears at birth and can affect one or both eyes. It’s the result of improper development of the eye during gestation. While the eye is forming, a gap called the choroidal fissure appears at the bottom of the stalks that will eventually form into the eyes. These gaps usually close by the seventh week of gestation, but if a gap doesn’t close, it will result in a coloboma. Colobomas that are visible at birth can be a sign of an undiagnosed syndrome. Your child’s doctor will need to perform a full workup if this occurs. Doctors can often correct colobomas with surgery.

Dermatochalasis

This condition occurs when excessive eyelid skin or fat hangs over the edge of the eye and obstructs vision. Your doctor can remove it surgically.

Ectropion

Ectropion occurs when one of the eyelids, usually the lower eyelid, turns outward. It exposes the inner eyelid and can cause irritation, dryness, and redness. Eye drops can help keep the eye moistened, and steroid ointment may also help. Taping the eyes shut when sleeping can also be a preventive measure. Surgery is usually necessary to correct this condition.

Entropion

Entropion occurs when one of the eyelids, usually the lower eyelid, turns inward. This causes the eyelashes to rub against the cornea and surrounding soft tissues, irritating them and causing redness and a discharge of mucus. Your doctor can treat it with eye drops and steroid cream until they can perform surgery to correct it. Entropion is most common in older adults.

Facial palsy

Palsies affecting the face, such as Bell’s palsy, can affect the eyelid. This results in an inability to close the upper eyelid, or a loss of muscle tension in the lower eyelid. Protecting the eyes by using eye drops and taping the eyes shut can help prevent conditions such as corneal abrasions or ulcerations.

Trichiasis

Trichiasis occurs when your eyelashes grow incorrectly and rub against the cornea. This can cause:

  • pain
  • irritation
  • redness
  • tear production

Removing the eyelashes corrects the problem. If the lashes persist in regrowing incorrectly, your doctor can surgically remove them. They can also permanently remove the hair follicle using electrolysis or cryotherapy.

Types of cancer that can occur on the eyelid

Basal cell carcinoma

Basal cell carcinoma is the most common type of cancer to occur on the eyelid. It usually appears on the lower eyelid or near the inner fold of the eye as a firm, pearly nodule. If the carcinoma appears on the edge of the eyelid, eyelashes may be missing around the tumor.

Basal cell carcinomas usually don’t metastasize, but they can spread to other areas near the original tumor. If they grow large enough, they can interfere with vision or eye movement.

If the tumor is small, your doctor can remove it with limited reconstruction. If it’s large, you’ll need surgery and complex reconstruction of the surrounding eye tissue. When surgery isn’t possible, radiation is another option. However, it has higher rates of complications, such as vision loss, and the cancer is more likely to return.

Squamous cell carcinoma

Squamous cell carcinoma spreads more aggressively than basal cell carcinoma. Lesions usually form on the upper eyelid and often begin as actinic keratosis. The lesion might be:

  • raised
  • scaly
  • bloodshot
  • raw

Treatment is similar to basal cell carcinoma, but more aggressive surgery often is necessary to cure it.

Sebaceous carcinoma

Sebaceous carcinoma occurs in older adults. It can look like a chalazion or blepharitis and can metastasize aggressively to other organs of the body. Large tumors might require removal of the eye to remove all of the cancerous tissue.

Melanoma

Melanoma is a rare form of eyelid tumor. These tumors are pigmented and are highly likely to metastasize, even if they’re small. Treatment involves aggressive surgery and potentially radiation.

Preventing eyelid disorders

Follow these tips to prevent the development of eyelid disorders:

  • Wash your eyelids regularly with warm water and baby shampoo to help prevent infections and inflammation.
  • Avoid touching or rubbing your eyes with your hands.
  • Wash your hands regularly.
  • Blepharitis is associated with dandruff, which is caused by bacteria. Use antidandruff or medicated shampoos to control the bacteria, but consult your doctor before using any of these shampoos.
  • Avoid allergens if you experience eye redness or swelling after being exposed to them. Stay indoors when pollen counts are high.
  • Use hypoallergenic makeup if regular makeup causes irritation.
  • Wear wide-brimmed hats and sunglasses that block ultraviolet rays to reduce your chances of developing cataracts and eye cancers.

What is the outlook for people with eyelid disorders?

Some eyelid disorders will go away with time or once an infection clears, but many can lead to serious chronic disorders if you don’t get treatment for them. These disorders include dry eye, astigmatism, or even vision loss. Contact an optometrist or ophthalmologist if you have a problem with your eyelids.

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