Eyelid Disorders

The eyelids play a key role in protecting the eyes. They sweep away debris when the eyes close and help spread moisture (tears) over the surface of the eyes when the eyes open. Some eyelid disorders and eyelid growths in older people are common and have only cosmetic significance. But others, like skin cancers on the eyelid, are more serious.

Ectropion

In ectropion, the lower eyelid grows lax and droops. The edge of the eyelid often turns outward (becomes everted).

Because the lower eyelid can no longer distribute tears across the eyeball or drain tears, tears fall onto the face instead. In addition, the lower eyelid may not close completely, thus the eye is exposed to the air and may become dry, red, and irritated. Artificial tears and ointments used at night may help the irritation, but most people need surgery.

Entropion

In entropion, the lower eyelid turns inward into the eye.

The lower eyelashes may rub against the eyeball, which in turn can cause tearing, irritation, infection, ulceration of the cornea, and scarring. Carefully placed stitches can pull the eyelid outward when scar tissue develops along the stitch. Botulinum toxin can pull the eyelid outward by paralyzing the muscle around the eye. However, these procedures offer only temporary solutions to the problem, and entropion eventually recurs. Correction with surgery offers the best hope of a permanent cure.

Eyelid Droop

Eyelid droop (ptosis) has several causes. The nerve that supplies the muscle of the upper eyelid may be paralyzed (this paralysis is often caused by diabetes). The cause can also be other neurologic diseases, such as Horner's syndrome and myasthenia gravis. Separation or stretching of the eyelid muscle where it connects to the eyelid can also result in eyelid droop. Surgery and injury to the eye are additional causes.

Eyelid droop usually causes no symptoms, although some people experience obstruction of vision as well as headache and fatigue from using their brow muscles while attempting to elevate their eyelids. Surgery is the only treatment available for eyelid droop and is necessary only if a person has symptoms. Complications of surgery include difficulty closing the eyes, dry eyes, and ulcers on the cornea.

Blepharitis

Blepharitis is inflammation of the edges of the eyelids.

It is sometimes caused by staphylococcal infection, and people with rosacea and seborrheic dermatitis are more likely to develop the condition. However, older people without these disorders frequently develop blepharitis for no apparent reason.

Blepharitis produces a range of symptoms, including a sensation of having something in the eye; itching, burning, swelling, and redness of the eyelid edges; watery eyes and sensitivity to bright light; and loss of eyelashes. Dried secretions may make the eyelids sticky after sleep.

Diagnosis is usually based on symptoms and on the appearance of the eyelids. Treatment consists of three measures: warm compresses, gently washing the eyelashes and eyelid edges with a dilute solution of baby shampoo, and use of antibiotic ointment or drops. Blepharitis is a chronic condition and can only be controlled, not cured. However, although blepharitis may be inconvenient or unattractive, it usually does not damage the eye.

Blepharospasm

Blepharospasm is a spasm of the muscles around the eye, causing involuntary blinking and closing of the eyes.

In severe cases, people with blepharospasm cannot open their eyes. Blepharospasm can occur as a result of other eye diseases, but its cause is more often unknown. It affects women more than men and tends to occur within families. Blepharospasm may also be more common in people with thyroid disease.

Spasms are often made worse by fatigue, bright light, and anxiety. Treatment involves injecting botulinum toxin into the muscles. Antianxiety drugs may also be of use. Surgery to cut the muscles is also effective but causes more complications than botulinum toxin. Sunglasses help decrease the light sensitivity that may cause or accompany blepharospasm.

Chalazion

Chalazion is a swelling of oil glands in the eyelid, usually because of a blocked duct.

The disorder occurs for unknown reasons and is most common in people with rosacea and blepharitis.

A person notices a chalazion when the eyelid becomes swollen, irritated, or red or when a painless swelling develops on or under the eyelid. A chalazion that is large enough can rub against the eyeball, causing irritation or, rarely, vision changes.

Treatment involves applying a warm compress to the eyelid several times a day. Even without treatment, a chalazion usually disappears after several months. If it persists, a doctor can inject a corticosteroid or drain the chalazion using a special spoon-shaped instrument (curettage).

Stye

A stye is an infected eyelid gland that is often difficult to distinguish from a chalazion.

Styes look like small, round swellings of the eyelid that may have a pinpoint yellow or white spot where the duct of the gland is blocked. Styes often accompany blepharitis and cause redness, tenderness at the edge of the eyelid, and a sensation that something is in the eye.

Warm compresses can open the infected gland. Antibiotic drops or ointments may also be useful. Surgery may be necessary for styes that do not respond to compresses or antibiotics.

Xanthelasmas

Xanthelasmas are flat yellow or white growths of the upper eyelid that appear thick and fatty.

Xanthelasmas in older people can occasionally be a sign of high cholesterol levels and therefore warrant a blood test.