Eyelid Disorders Health Article

Definition

An eyelid disorder is any abnormal condition that affects the eyelids.

Description

Eyelids consist of thin folds of skin, muscle, and connective tissue. The eyelids protect the eyes and spread tears over the front of the eyes. The inside of the eyelids are lined with the conjunctiva of the eyelid (the palpebral conjunctiva), and the outside of the lids are covered with the body's thinnest skin. Some common lid problems include the following: stye, blepharitis, chalazion, entropion, ectropion, eyelid edema, and eyelid tumors.

Stye

Styes are treated with warm-hot compresses for 10–15 minutes, three to four times a day. Sometimes topical antibiotics may be prescribed. If the initial treatment is ineffective, styes are lanced and drained.

Chalazion

About 25% of chalazia will disappear spontaneously, but hot compresses may speed the process. Because chalazia are inside the lid, topical medications are generally of no benefit. Medication may need to be injected by the doctor into the chalazion or if that doesn't help the chalazion may need to be excised. If what appears to be a chalazion recurs on the same site as any previous one, the possibility of sebaceous gland carcinoma should be investigated by biopsy.

Blepharitis

Blepharitis is treated with hot compresses, with antibiotic ointment, and by cleaning the eyelids with a moist washcloth and then with baby shampoo. Good hygiene is essential. If the blepharitis doesn't clear up with treatment or if it seems to be a chronic problem, the patient may have acnerosacea. These patients may need to see a dermatologist as well.

Entropion

Entropion usually results from aging, but sometimes can be due to a congenital defect, a spastic eyelid muscle, or a scar on the inside of the lid that could be from surgery, injury, or disease. It is accompanied by excessive tearing, redness, and discomfort.

Ectropion

Similar to entropion, the usual cause of ectropion is aging. It also can be due to a spastic eyelid muscle or a scar, as in entropion. It also can be the result of allergies. Symptoms are excessive tearing and hardening of the eyelid conjunctiva.

Eyelid edema

Patients with swollen eyelids should contact their eye doctor. A severely swollen lid can press on the eye and possibly increase the intraocular pressure. An infection needs to be ruled out. Or, something as simple as an allergy to nail polish and then touching the eyes can cause swelling. The best treatment for allergic eyelid edema is to find and remove the substance causing the allergy. When that is not possible, as in the case of plant allergens, cold compresses and immunosuppresesive drugs such as corticosteroid creams are helpful. However, steroids can cause cataracts and increase intraocular pressure and patients must be very careful not to get the cream in their eyes. This should not be done unless under a doctor's care. For edema caused by trichinosis, the trichinosis must be treated.

Eyelid tumors

Cancerous tumors should be removed upon discovery, and noncancerous tumors should be removed before they become big enough to interfere with vision or eyelid function. Eyelid tumors require special consideration because of their sensitive location. It is important that treatment not compromise vision, eye movement, or eyelid movement. Accordingly, eyelid reconstruction will sometimes accompany tumor excision.

Diagnosis

An instrument called a slit lamp is generally used to magnify the structures of the eyes. The doctor may press on the lid margin to see if oil can be expressed from the meibomian glands. The doctor may invert the lid to see the inside of the lid. Biopsy is used to diagnose cancerous tumors.

Entropion and ectropion

Both entropion and ectropion can be surgically corrected. Prior to surgery, the lower lid of entropion can be taped down to keep the lashes off the eye, and both can be treated with lubricating drops to keep the cornea moist.

Prognosis

The prognosis for styes and chalazia is good to excellent. With treatment, blepharitis, ectropion, and entropion usually have good outcomes. The prognosis for nonmalignant tumors, basal cell carcinoma, and squamous cell carcinoma is good once they are properly removed. Survival rate for malignant melanoma depends upon how early it was discovered and if it was completely removed. Sebaceous carcinomas are difficult to detect, so poor outcomes are more frequent.

All of these eyelid disorders, if not treated, can lead to other, possibly serious vision problems—dry eye, astigmatism, or even vision loss, for example. An ophthalmologist or optometrist should be consulted.