Eyelid Disorders

Written by Rachel Barclay | Published on November 14, 2013
Medically Reviewed by George Krucik, MD, MBA on November 14, 2013

What Are Eyelid Disorders?

An eyelid disorder is a condition that specifically affects the eyelid.

These disorders can include drooping, twitching, inflammation, paralysis, and growths. Occasional fluttering of one eyelid is normal.

Eyelid Disorders Caused by Inflammations

Blepharitis

Blepharaitis 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, or redness of the eye. Blepharitis can often lead to a stye or a chalazion. Blepharitis can be treated with warm compresses, cleaning the eyelids with a moist washcloth and baby shampoo, and antibiotic ointment.

Stye (Hordeolum)

A stye is a red, sensitive bump that appears on the edge of the eyelid. It is caused by bacterial infection of a hair follicle or sweat gland. Styes usually recede on their own over time. Applying warm, moist compresses several times a day can help styes heal faster. If the stye does not recede, a physician may prescribe antibiotics.

Chalazion

A chalazion is a lump on the eyelid. It is caused by obstruction and inflammation of an oil gland. Some will disappear spontaneously, although hot compresses speed the process. Medication or surgery can treat or remove the chalazion. If a chalazion regrows in the same place, it might be pre-cancerous.

Meibomianitis (Posterior Blepharitis)

Meibomianitis, or posterior blepharitis, occurs when the eye’s oil glands at the base of the eyelashes become clogged. The eyelid thickens and may become crusty. It is treated the same way as anterior blepharitis.

Lacrimal Duct Obstruction

The tiny hole at the inner corner of each eye leads to the lacrimal duct. This duct drains tears from the eye into the nose. When the duct becomes blocked, it can become inflamed or infected. The area will swell and may discharge mucus. Irritation, itching, tearing, stinging, and burning are common. Many obstructions clear spontaneously. Hot compresses speed the healing process. The area may also be massaged to help clear the blockage. Topical and oral antibiotics can treat infection. Surgery is an option as a last resort.

Eyelid Disorders Caused by Lesions

Seborrheic Keratosis

Seborrheic keratoses are oily, pigmented lesions that look like they are stuck to the skin. They are common in the elderly and easily irritated. They can be removed surgically.

Actinic Keratosis

Actinic keratosis appears as a patch of flat, white, flaky, or scaly skin. It can be the precursor to carcinoma.

Hydrocystoma

A hydrocystoma is a clear cyst found near the edge of the eyelid. It is usually caused by blockage of sweat glands. It can be removed surgically.

Molluscum Contagiosum

These are small, waxy nodules that are caused by viral infection in immunocompromised patients. They can cause inflammation of hair follicles if they occur near an eyelash. They can be removed by surgery or freezing, although they often clear up on their own as the viral infection subsides.

Nevus

Nevi are small lesions. They can be flat or elevated, pigmented, or nonpigmented. Nevi are genetic. They are usually not pre-cancerous, but if one changes in appearance, becoming irregular in color or shape, it should be removed surgically.

Xanthelasma

Xanthelasma are soft, yellowish patches that can appear below the lower fold of the eye. They are caused by genetic factors or high cholesterol. Xanthelasma can be removed by surgery or with a carbon dioxide laser.

Mechanical Eyelid Disorders

Blepharospasm (Eyelid Twitch)

A blepharospasm is an abnormal, involuntary muscle spasm of the eyelid. It can appear as repetitive blinking, twitching, or fluttering. It should not be confused with non-pathological eyelid fluttering, which does not affect the rest of the face. It can affect anyone from time to time during times of sleep deprivation or stress.

Types of blepharospasm include:

  • Benign Essential Blepharospasm (BEB). BEB occurs on both sides of the face. It is a form of dystonia, a disorder that causes involuntary muscle contractions due to the basal ganglia malfunctioning. BEB develops slowly. 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 more intense, often forcing the eyes closed for periods of time. This can cause people with severe BEB to become functionally blind, although there is nothing wrong with their eyes. BEB occurs in men and women, but is most common among elderly women. To treat BEB, some medications have proven effective in 15 percent of patients (NEI, 2009). Surgery can sometimes stop the muscle spasms, but this causes permanent damage to the eyelid. Instead, patients can get injections of botulinum toxin to relax or paralyze the spasming muscles.
  • Hemifacial Blepharospasm. This is when spasms occur on only one side of the face. These spasms are usually caused by irritation of nerves in the face. Since about 1 percent of hemifacial blepharospasms are caused by tumors, people experiencing facial spasms on one side of their face should receive magnetic resonance imaging (MRI) scan of the brain (Carter, 1998).

Blepharoptosis (Eyelid Drooping)

A blepharoptosis, or ptosis, occurs when the upper eyelid droops. If the eyelid droops far enough, it can block the pupil. This can cause partial blindness. There are a variety of causes of ptosis, including: 

  • Congenital Ptosis. An infant can be born with ptosis that is caused by developmental problems of the levator, the muscle that lifts the upper eyelid. The condition usually affects one eye. If the eyelid droops low enough to obscure the visual field, the baby must receive surgery to correct the ptosis and clear vision. Otherwise, the child may develop lazy eye or permanent vision loss.
  • Aponeurotic (Aging-Related) Ptosis. Most non-congenital ptosis is the result of aging. The long-term effects of gravity 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. This can also be corrected with surgery.
  • Myasthenia Gravis. Ptosis can be one of the early symptoms of myasthenia gravis. This is a rare disease that causes progressive muscle weakness in the face and elsewhere in the body.
  • Other Causes: Ptosis can also be caused by other medical conditions that affect the nerves or muscles. These include congenital muscle diseases, stroke, brain tumor, brain aneurysm, nerve damage from diabetes, infection of the eyelid, or trauma to the eyelid. 

Coloboma

A coloboma is a gap of missing tissue in the eye. This appears at birth and can affect one or both eyes. It is 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 the eyes. These gaps usually close by the seventh week of gestation. If a gap does not close, the result will be a coloboma. It can generally be corrected with surgery.

Dermatochalasis

Excessive eyelid skin or fat can hang over the edge of the eye and obstruct vision. This is called dermatochalasis. It can be removed with surgery.

Ectropion

Entropion 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. Steroid ointment may also help. Surgery is generally required to correct the 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. This irritates them and causes redness and mucous discharge. It can be treated with eye drops and steroid cream until surgery can be performed to correct it. Entropion is most common among the elderly.

Facial Palsy

Palsies affecting the face, such as Bell’s palsy, can also affect the eyelid. Palsy can result in the inability to close the upper eyelid, or loss of muscle tension in the lower eyelid.

Trichiasis

Trichiasis occurs when eyelashes grow incorrectly and rub the cornea. This can cause pain, irritation, redness, and tear production. Removal of the misgrowing eyelashes will correct the problem. If the lashes persist in regrowing incorrectly, they can be removed again. Alternatively, the hair follicle can be permanently destroyed with electrolysis or cryotherapy.

Eyelid Disorders Caused by Cancers

Basal Cell Carcinoma

Basal cell carcinoma is the most common type of cancer to afflict 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 do not metastasize. They can spread to other areas nearby the original tumor.

This type of tumor is usually treated by surgical removal and reconstruction of the surrounding eye tissue. When surgery is not possible, radiation is a second possible treatment, but it has higher rates of complications 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 can often begin as actinic keratosis. The lesion might be raised, scaly, bloodshot, or raw. Treatment is similar to basal cell carcinoma.

Sebaceous Carcinoma

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

Melanoma

Melanoma is a rare form of eyelid tumor. These tumors are pigmented. Melanoma is highly likely to metastasize.

What Is the Outlook for Eyelid Disorders?

The prognosis for eyelid disorders depends on the cause.

Many eyelid disorders can lead to serious chronic disorders if they are not treated. These disorders include dry eye, astigmatism, or even vision loss. Contact an optometric or ophthalmologist if you have an eyelid disorder.

Preventing Eyelid Disorders

Employ caution when using soap or any product near the eyes.

To prevent the development of eyelid disorders, employ good lid hygiene. Wash the eyelid regularly with warm water and baby shampoo to help prevent infections and inflammation. Try to avoid touching or rubbing the eyes with your hands. Wash your hands regularly. 

Blepharitis is associated with dandruff production, which is caused by a certain type of bacteria. Use anti-dandruff or medicated shampoos in consultation with your physician to control the bacteria.

Avoid allergens if you experience eye redness or swelling from exposure to them. Stay indoors when pollen counts are high. Use hypoallergenic makeup if regular makeup causes irritation.

Wide-brimmed hats and UV-blocking sunglasses can help reduce your chances of developing cataracts and eye cancers.

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