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
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
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.
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
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
Eyelid Disorders Caused by Lesions
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 appears as a patch of flat, white,
flaky, or scaly skin. It can be the precursor to carcinoma.
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
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
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 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)
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.
of blepharospasm include:
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.
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,
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:
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.
(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.
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.
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.
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.
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
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 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.
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 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 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 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
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.