Eyelid Disorders: Overview

Eyelid disorders are problems that cause pain, swelling, or inflammation on the eyelid.

The purpose of the eyelid is to protect the eye. Eyelids help to keep moisture on the surface of the eyes to prevent the eyes from drying out. When something is coming toward the eyes, such as flying particles, people blink to protect their eyes from injury. When something such as a particle of dust or makeup, or an eyelash gets in the eye, people blink to try to remove the foreign substance from the eye.

There are several specific disorders of the eyelid: blepharitis, chalazion, ectropion, entropion, eyelid bump, drooping eyelid, and twitching eyelid.

Blepharitis (blef-U-rIt-us) is a swelling or inflammation of the eyelid. It is caused by an overproduction of oil by the glands near the eyelid. These glands are called meibomian glands * , and they are located in the eyelid directly behind the eyelashes. As the oils break down, they may cause inflammation to develop. Infection may develop from bacteria (usually staphylococcal) or viruses (usually herpes simplex or cold sores). People who have the skin conditions seborrheic dermatitis or rosacea are more likely to get blepharitis. In rare cases, an allergy that affects the eyelashes may cause blepharitis. For example, an allergy to mascara or the ingredients in mascara may result in blepharitis. Also, people who have a greater than normal growth of bacteria normally found on the skin are at higher risk for developing blepharitis.

Ectropion (ek-TRO-PE-on) is the turning outward of the eyelid (usually the lower eyelid) so that part of the surface of the eye is exposed. Ectropion is most often related to the aging process, and thus is most commonly seen in older adults. The connective tissue that gives the eyelid its form and tone becomes weaker as people age, causing the lid to turn out. Ectropion can also be a result of palsy or paralysis of the facial nerves, or of scar tissue from facial burns. It can also be a birth defect. For example, ectropion is often seen in children with Down syndrome * .

Entropion (en-TRO-PE-on) is the turning inward of the edge of the eyelid (usually the lower eyelid), which causes the eyelashes to rub against the eye. Entropion can be present at birth (congenital) and it is seen in older adults. In older people, entropion is caused by weakening of the muscles that surround and support the lower part of the eye. Trachoma * , an eye disease seen in many underdeveloped nations, and chemical burns to the face can also cause entropion.

An eyelid bump is a bubble or bump at the edge of the eyelid, usually a stye (hordeolum) or a chalazion. Some people get small yellow bumps on the eyelids. These are usually associated with older age.

A drooping eyelid is a condition of the upper eyelid. It may affect one eye (unilateral) or both eyes (bilateral). A drooping eyelid may be present from birth or related to aging. Drooping eyelids may also be associated with migraine headaches * , diabetes, stroke, Horner syndrome, myasthenia gravis, or a brain tumor.

The most commonly occurring eyelid disorders are blepharitis and chalazion. Both are types of inflammation of the eyelid and can reoccur, especially in people who frequently touch their eyes.

Most eyelid disorders are not contagious. However, a hordeolum or stye can be a precursor to a chalazion. A stye (hordeolum) is an infection of the eye caused by staphylococcus, a bacteria that can be found normally in various places in the body. For example, if a person rubs their nose (a place where staphylococcus may be found) and then touches their eye or someone else's eye, a staphylococcal infection can develop in the eye.

Signs of blepharitis include itchy, red, swollen eyelids and watery eyes. People may have a scab-like crust that clings to the base of the eyelashes and may complain of a burning feeling in the eyelids or a feeling that there is a foreign substance in the eye.

While the hordeolum is still present, the eyelid may be red, swollen, warm, and tender. Although there may be drainage associated with the preexisting hordeolum, there is no drainage with the chalazion; rather, the chalazion is a firm nodule that forms in the affected meibomian gland.

Signs of ectropion include an outward turning of the eyelids and dry, red, painful eyes. Excess tearing of the eye causes tears to overflow the lower lid. People may also develop chronic * conjunctivitis, an inflammation of the mucous membrane that covers the front surface of the eye and lines the inner surface of the eyelids.

Signs of entropion are pain, redness, and irritation of the eyes. There is increased tearing (watering) of the eyes. If the cornea becomes damaged, there may be a decrease in vision.

Signs of eyelid bump are an increased sensitivity to light, the gritty sensation of a foreign body in the eye, tearing of the eye, and tenderness of the eyelid.

Drooping eyelid is noted by observing the eye. One or both eyelids may droop and there may be increased tearing of the eyes. If the droop is severe, vision may be affected.

Affected people may report blurred vision, sensitivity to light, and repeated, uncontrollable twitching of one or both eyelids.

Healthcare providers obtain a medical history related to the problem, asking questions such as: When did the problem start? How long has the problem existed? Was any type of treatment done for the problem? Is there anything that causes it to become worse? Is there anything that helps it get better? Does it interfere with vision? Are there any other associated problems? The eyes are then examined and visual ability may be tested. Depending on the specific condition, a thorough examination of the eye may be done, including assessing visual fields to determine whether the condition interferes with vision. Patients may be referred to an ophthalmologist, who specializes in diseases of the eye.

Treatment consists of cleaning the edges of the eyelid with a solution of warm water and a mild cleanser (such as baby shampoo) several times a day. In some cases, an antibiotic * (for bacterial infection) or antiviral * (for viral infection) ointment applied to the edge of the eyelid may be prescribed. If the problem is associated with an allergy, the person should stop using the agent (such as eye makeup) causing the allergy.

A chalazion usually goes away without treatment. Applying warm, wet compresses over the eyelid for 10 to 15 minutes several times a day may help healing. Disposable cosmetic pads can be used as compresses and should be discarded after use to avoid transferring any infection.

Artificial tears or ointments are recommended to lubricate the eyes. Surgery may be done to tighten the muscles that hold the eyelids in place.

Artificial tears or ointments are recommended to keep the eyes lubricated. Surgery may be done to tighten the muscles that hold the eyelids in place.

Treatment consists of applying a warm, wet cloth (compress) to the eyelid several times a day. In some cases, an antibiotic ointment applied to the eyelid may be recommended. Disposable cosmetic pads can be used as compresses and should be discarded after use to avoid transferring any infection.

Treatment of a twitching eyelid is related to the cause. For example, if the condition is related to too much caffeine intake, decreasing or avoiding caffeine can help stop the twitching.

Some strategies that can prevent infection or irritation of the eye include washing the eyes with a gentle cleanser such as baby shampoo twice a day, avoiding touching the eye and the surrounding tissues, and washing hands thoroughly before touching the eye and the surrounding tissues. Using disposable applicators to apply eye makeup and discarding them after each use can also prevent the transfer of infection.

See also Dermatitis • Pink Eye (Conjunctivitis) • Rosacea • Staphylococcal Infections

* meibomian gland is a gland located on the inner rim of the eyelid. The meibomian glands secrete oil that prevents evaporation of tears on the eye. Also called tarsal glands.

* Down syndrome is a genetic disorder that can cause intellectual disability, shortness, and distinctive facial characteristics, as well as many other features.

* trachoma (trahk-o-ma) is a specific bacterial infection of the eye causing inflammation on the inner surface of the eyelids.

* migraine headache is a headache that is usually located on one side of the head; is pulsating or throbbing in nature; and is often accompanied by nausea, vomiting, and sensitivity to light.

* chronic (KRAW-nik) means lasting a long time or recurring frequently.

* antibiotic (an-tie-by-AH-tik) is a drug that kills or slows the growth of bacteria.

* antiviral is a substance or medication used to treat or prevent a viral infection.