|
|
|
 |
|
Richmond Eye Associates
Eye Health and Disorders
|
|
|
Introduction: Eyelid Problems
The eyelids have many functions,
including protecting and lubricating the eye, producing oil secretions for the
eye, and helping to drain away tears. This page includes a variety of eyelid
problems ranging from lumps and bumps of the eyelid to twitching of the lid.
Eyelid malpositions (in-turning and out-turning) and drooping eyelids (ptosis)
are discussed as well.
Other eyelid related problems that are discussed on other pages of this Symptom
and Diagnosis section are listed below with possible distinguishing features.
Read this important information
before proceeding further:
These sections are not intended to replace the professional examination and
diagnosis by a physician, and they are presented here purely for informational purposes.
All possible diagnoses and treatment options are not covered, and the information
discussed should not be taken as a recommendation to self-diagnose and self-treat a
condition. A misdiagnosed or improperly treated eye condition can result in a permanent
loss of vision, or a permanent loss of function of the eye or visual system. In the case
of any eye problem, seek medical attention promptly. This can include emergency room
treatment, as well as treatment by a medical physician or eyecare provider.
|
Conditions Discussed on this Page:
For eye anatomy explanations, go to
ANATOMY
-
A chalazion, or stye, appears as a well defined lump within the eyelid. The upper and
lower eyelids each contain about 30 oil secreting glands that open at the edge of the lid,
and travel deep within the tarsal plate of the eyelid. If one or more of these glands becomes
blocked, the gland continues to make the secretion, but this is trapped within the lid and
eventually forms a rounded lump within the lid. There may be mild soreness initially since
the trapped material creates some inflammation in the eyelid. The swelling may protrude
toward the eye, toward the outside and appear to be just under the skin, or protrude at
the edge of the eyelid. Conditions such as blepharitis and rosacea may lead to chalazion
formation.
In most cases, the chalazion will drain spontaneously if hot compresses are
applied to the eyelid a few times a day for a few days to a week. Sometimes an antibiotic
ointment or an oral antibiotic may help. In cases where the chalazion does not drain, it
can be drained surgically under local anesthesia in the office. This procedure should not
be overdone, since it may lead to the loss of numerous glands in the eyelid, which could
lead to a dry eye problem in some people.
Sometimes a chalazion leads to the formation of a "granuloma", which is a
reactive fleshy growth on the inside of the eyelid. This too can be removed if necessary.
Lumps in the eyelid can put pressure on the eye which can temporarily cause astigmatism,
or a change in the shape of the eye.
Return to Condition List
-
Cellulitis is an infection of the eyelid, and is more severe than the more low-grade
"blepharitis", which
usually causes only itching or burning symptoms. Cellulitis causes diffuse swelling of the
entire eyelid, which is usually tender, hot, and red. The swelling may extend onto the
face, and there may be discharge present. Cellulitis of the lower eyelid can mimic
infection of the tear drainage sac (dacryocystitis).
It is important to distinguish infection involving only the eyelid from infection
extending from behind the eye, or the orbit (orbital cellulitis), which is usually more severe and causes eye
protrusion and double vision.
Eyelid cellulitis is treated with oral antibiotics, and
sometimes with IV antibiotics in more severe cases. It is important to watch for extension
of the infection into the orbit.
Return to Condition List
-
Ectropion, or out-turning, of the eyelid usually involves the lower eyelid. The lower
eyelid pulls away from the eye and visibly appears to sag down. Symptoms include
irritation, swelling, and redness of the eyelid, tearing, and irritation and redness of
the eye. The lower eyelid is usually pressed flush against the eye and keeps the eye
bathed in lubricating tears. When the eyelid sags away, so do the tears, and the eye can
become severely dry. Tearing occurs if the opening in the eyelid which drains tears away
becomes separated from the eye. Thus, tears have no way to drain away except onto the
face. Dryness of the cornea can lead to a scratchy sensation, redness of the eye, pain,
and blurred vision. Sometimes the cornea can become infected.
Most of the time,
ectropion occurs along with the general aging changes in the skin. The lower eyelid can
become looser, and eventually pull away from the eye by gravity. Bell's Palsy, or a
temporary paralysis of the side of the face, can suddenly make these normal aging changes
much worse, and the eye can become severely dry due to ectropion. Other conditions lead to
scarring of the skin under the eyelid, which pulls the eyelid away from the eye.
Treatment of ectropion in some cases is merely to lubricate the eye as best as
possible, with artificial tears during the day and ointment at night. In more severe
cases, or if the cornea is at risk due to severe dryness, the eyelid out-turning can be
corrected surgically under local anesthesia.
Return to Condition List
-
Entropion, or in-turning, of the eyelid can involve the upper or lower eyelid. Symptoms
occur due to the scratching of the eye by the inwardly pointing eyelashes (trichiasis). Usually numerous eyelashes
are involved, and it is impractical to pull all of them. This condition can occur due to
generalized aging changing in the eyelid with a gradual rotation inward. Other cases are
caused by scarring, either from trauma, infection, or an inflammatory condition such as
shingles of the eyelid.
In cases where the eye is being severely scratched by the
entropion, surgery can be performed emergently to reposition the lid. Other less severe
cases might be able to be managed using lubricating eye drops and ointments
on the eye, but usually surgery will need to be performed.
Return to Condition List
-
This discussion of eyelid tumors includes growths present on the skin, the edge, or the
inside surface of the eyelid. A chalazion, or stye, which is a
lump within the eyelid, is covered in a section above.
-
Skin cancer of the eyelid
appears usually as a slowly enlarging lump usually on
the lower eyelid. The most common type is "basal cell" cancer, which usually is
a firm, pearly nodule which is non-tender. If present at the edge of the eyelid, there may
be a loss of eyelashes. Another type of skin cancer of the eyelid resembles a chronic
infection of the lid, or blepharitis, with redness of the lid. Melanoma can involve the
outside or inside of the eyelid, and usually is a changing, darkly pigmented growth.
Sometimes melanomas have no pigment.
Treatment of suspicious growths is by excisional
biopsy with examination in the laboratory to determine if the growth is cancerous, and if
it has been removed completely.
-
Non-cancerous growths of the eyelid include:
-
Skin tags or horns, which are fleshy growths of skin on a stalk. These can be removed if
necessary.
-
Seborrheic keratoses, which are "stuck-on appearing" growths on the skin.
These are more of a cosmetic problem and rarely have to be removed.
-
Inclusion cysts, which are round, bubble-like swellings on the eyelid which may come and
go. If simply drained, they usually recur.
-
Viral papilloma, or wart-like growths, are fleshy growths usually on the edge of the
eyelid. These can be removed if necessary.
-
Granulomas are inflammatory growths on the inside or outside of the eyelid, and can
occur after a stye, or chalazion.
-
Molluscum contagiousum is a small viral growth of the eyelid or skin which can
spread. Usually it is a tiny, round, white lump on the lid. Viral particles shed from this
can irritate the eye and lead to itching and redness. Treatment is by excision.
-
Calcifications, or "concretions" can occur on the inside of the
eyelids. If the eyelid is flipped over, a small, very white particle or cluster of
particles may be seen on the inside surface. Usually these are covered over by a
transparent membrane that lines the inside of the eyelid. Rarely do they erode and scratch
the eye, and rarely do they ever have to be removed.
Return to Condition List
-
Twitching of the eyelid is a common, and annoying problem. Usually a tiny piece of
muscle beneath the skin of the upper or lower eyelid seems to rhythmically and
uncontrollably twitch. Often it is barely visible to other people observing the eyes. The
muscle fibers beneath the skin of the eyelid run in a circle around the eye, so the twitch
seems to also pull toward the inside or outside.
Causes include local eye irritation
such as dry eye and blepharitis, and artificial tears may help. Fatigue, stress, and lack
of sleep are other known causes. Stimulants such as caffeine and decongestants may also
lead to twitching. Rarely, pulsation of an artery on a nerve controlling the muscle causes
twitching.
Usually the eyelid twitching will resolve with time spontaneously. A more severe
version of this, called blepharospasm, leads to severe, uncontrollable squeezing of the
eyelids closed. This problem can be treated if necessary by medication such
as Botox injections. This problem
usually needs evaluation by an ophthalmologist.
Return to Condition List
- Several problems can lead to drooping of the upper eyelids, called ptosis (toe-sis).
Some people are born with this condition, and live their lives with no complaints or
symptoms. This may not even be a cosmetic problem, if it is symmetrical between the two
eyes (as in some photos of Marilyn Monroe). However, for people who develop worsening
ptosis in one eye or the other, it can become a battle to keep the eyes open. Significant
ptosis of the upper lids can block the upper field of vision. Causes include:
- Aging changes - in some people the muscle that lifts the upper eyelid slips back with
time and the eyelid droops.
- Trauma - a blow to the eye or a laceration can damage or disinsert the muscle
controlling the height of the eyelid.
- Eye surgery - for an unknown reason, some people will develop ptosis after cataract
surgery, or other eye surgeries.
-
Myasthenia gravis - this unusual
disorder leads to a temporary, often severe, drooping of one or both eyelids. At other
times, the height of the lids can be completely normal. This may be associated with muscle
weakness and fatigue, as well as a variable double vision. It is treatable with
medication.
- Nerve paralysis - one of the nerves that control eye movement also controls the muscle
which lifts the eyelid. If the affected eyelid is raised, usually the person will have
double vision. This is discussed more in the section on
nerve paralysis. Another condition called "Horner's
syndrome" can cause this also, along with a small pupil on one side. Both of these
conditions need prompt evaluation by a ophthalmologist.
- Brow ptosis - in this condition, common in men, the entire brow area drops down. If
folds of skin then block the vision, surgical correction can be done.
- Some people develop loose overhanging skin of the eyelids, or develop pockets of fat
which protrude and bulge in the eyelids. This can be corrected surgically if necessary or
desired.
Ptosis which encroaches on the pupil and is blocking the upper field of vision can be
surgically corrected. Less severe ptosis can be corrected with cosmetic surgery.
-
Return to Condition List
|
|
|
