Eyelids are more than just a kind of shutter that closes over your eyes to allow you to sleep at night. These delicate folds of skin also protect your eyes from damage. Each time you blink, your eyelids spread tears across the surface of your eyes to keep them clean and lubricated. Blinking pushes tears toward your tear ducts, so they can drain out.
Like many other parts of the body, eyelids can become irritated or infected. As we age, they can sag or droop, getting in the way of seeing. Fortunately, most common eyelid disorders can be easily treated and even prevented. Here’s what you need to know.
Ptosis and dermatochalasis
Both conditions refer to a similar problem: drooping eyelids. One type of adult ptosis occurs when the levator muscle, which lifts the eyelid, stretches or separates from the eyelid. Dermatochalasis is caused by loose or excess eyelid skin. Both ptosis and dermatochalasis become more common with age. For most people, saggy eyelids are a cosmetic concern. But if your eyelids become too droopy, they may cover your pupil and impair vision.
What can be done: Dermatochalasis is corrected with a procedure called blepharoplasty, which is the most common operation performed by ophthalmic plastic surgeons. An incision is made within the upper eyelid crease, so it’s less likely to leave a visible scar. Excess skin and, in some cases, small amounts of fat are removed from the eyelid.
Ptosis is treated by making a small tuck to tighten the levator muscle that’s often enough to allow the eyelid to lift properly. For more severe ptosis, your doctor may recommend surgery to reattach and strengthen the levator muscle. If there is excess skin or fat, it may be removed at the same time.
These outpatient procedures require only a local anesthetic to numb the eyelid and surrounding area. Drops are used to numb the eye. Although there may be some bruising and discomfort afterwards, most people recover quickly.
Blepharitis refers to inflammation of the eyelids. Symptoms include redness, irritation, itching, and dandruff-like scales forming at the base of the eyelashes. Blepharitis can be caused either by bacteria or by skin conditions such as dandruff or rosacea. It isn’t contagious. But untreated, it can cause eyelashes to fall out and may lead to inflammation of other parts of the eye, particularly the cornea.
What can be done: Good eye hygiene is often enough to treat blepharitis and prevent it from coming back. If you’re prone to blepharitis, keeping your eyelids clean is especially important.
- Apply a warm, clean washcloth to the lids, and using a few drops of diluted baby shampoo, wash away any oily debris or scales at the base of your eyelashes. Pre-packaged lid scrubs are also available over the counter.
- Gently massage your eyelids to help clean out oil that may accumulate in your eyelid glands.
Avoid eye makeup and contact lenses until the inflammation goes away. If your symptoms persist, see your doctor. If you have a stubborn bacterial infection, you may need an antibiotic ointment.
Entropion and ectropion
These two conditions occur when the edges of the eyelids change their position, usually because of aging.
Entropion occurs when the edge of the lid turns inward, so that your eyelashes and eyelid skin rub against the front part of your eye. Over time, this rubbing can cause excess tearing, redness, pain, crusting of the eyelid, irritation, and impaired vision. Ectropion occurs when your eyelid turns outward. When that happens, your eyelids don’t sweep evenly across the surface of your eyes. Symptoms include excess tearing, irritation, crusting of the eyelid, and mucous discharge.
What can be done: Artificial tears, which moisturize the eye, may help relieve the discomfort of entropion or ectropion. But often surgery is required to correct the problem. It is usually an outpatient procedure using local anesthesia.
Styes and chalazia
Both styes and chalazia (plural for chalazion) are small, inflamed lumps that form on the eyelid. A stye (also called a hordeolum) is typically caused by a bacterial infection. Your eyelid may become inflamed, and your eye may also feel sore and scratchy. A chalazion forms when an oil gland in the eyelid becomes clogged. Your eyelid may get red, swollen, and slightly tender to touch. If a chalazion gets too large, it can press on your eye and cause blurry vision. In rare cases, the whole eyelid can become swollen. People with blepharitis are at greater risk of developing styes.
Distinguishing between a stye and a chalazion can be tricky. One difference is that a stye is usually very painful. A chalazion is usually just tender. Some styes form at the base of the eyelashes and are usually caused by an infection of the hair follicle. Others, typically caused by an infected oil-producing gland, form inside the eyelid. A chalazion begins farther back on the eyelid and rarely causes the entire eyelid to swell. Distinguishing between them is also difficult because one can sometimes develop into the other if left untreated.
What can be done: Styes and chalazia usually clear up on their own in a few weeks to a month. If you notice any sort of lump, do not attempt to squeeze or “pop” it, or you may cause more damage. Instead, apply warm compresses to your eyelid for 10 to 15 minutes, four to six times a day.
If you have a chalazion, applying a warm compress or gently massaging the area helps unblock the clogged oil duct. For a stye, warm compresses help the infection resolve on its own. Avoid rubbing or touching your eyelid, which can spread the infection.
A stye usually takes a week to improve. A chalazion may take up to a month. If they don’t get better, begin to affect your vision, or keep recurring, see your doctor. A stubborn chalazion may need to be treated with a corticosteroid injection or surgically drained. For a stye that won’t heal, your doctor may prescribe an antibiotic ointment or eyedrops or, if it persists, lance the stye to allow the infection to drain.
Benign essential blepharospasm
Blepharospasms are abnormal contractions of the eyelids.Benign essential blepharospasm (BEB) refers to a spasm that is not a symptom of any other disease. Researchers don’t know exactly what causes these spasms. They may be mild and infrequent at the beginning but then become stronger and more frequent. In some cases, they become severe enough to interfere with vision. Secondary blepharospasm refers to abnormal contractions that are a symptom of an underlying condition. Because some of these conditions may be serious, your doctor may suggest tests to rule out any other cause before making a diagnosis of BEB.
What can be done: There is no cure for BEB. If the symptoms are very annoying, your doctor may recommend a botulinum toxin (Botox) injection. The injection temporarily paralyzes the muscles that are causing the twitch. The effects wear off over time, however. In more extreme cases, your doctor may perform a procedure to remove some of the muscle that’s causing the twitch.
This article first appeared in the 2019 UC Berkeley Vision White Paper.
Also see Coping with Watery Eyes.
Published July 19, 2019