Eye Lid Disorders

ENTROPION

Entropion is a condition characterized by the inward folding of the eyelids (usually the lower lid). This can cause the eyelashes and skin to rub against the surface of the eye leading to irritation and damage to the eye. It can be congenital (present at birth), but rarely causes problems in babies as the eyelashes are so soft. In elderly, it is caused by weakening of the muscles and tendons under the eyes.

ECTROPION

Ectropion is a condition characterized by outward turning of the eyelids (usually the lower lid). It is usually found in the elderly, where the muscles surrounding the eye become weak with ageing. It can be congenital, and can also be found in patients with facial palsy or scarring of the eyelid. Ectropion prevents the eyelid from closing properly and protecting the cornea (transparent front part of the eye).  This can damage the cornea and affect normal vision.

LID DEFECTS

Lid defects can occur as a result of the normal ageing process, birth defects, trauma, or other medical diseases. These may affect the appearance, position, and/or function of the eyelids.  Most of these defects can be treated on an outpatient basis under local anesthesia in your doctor’s office. Some of the lid defects include:

Baggy eyelids: As you age, loose skin and lax muscles along with a buildup of fat can form bags under your eyelids. This can affect your appearance and make your eyes look tired.

Droopy eyelids (eyelid ptosis): Droopy eyelids can block the upper part of your vision and decrease your ability to hold your eyes open. It is more common in elderly as a part of the normal ageing process. It can also be present at birth when the muscles that lift the eyelids are not fully formed.

Eyelids opening too widely (eyelid retraction): This condition is more prevalent in patients with thyroid eye disease (TED). It can be caused due to abnormalities of the eye muscles, and is characterized by the superior displacement of the upper eyelid or inferior displacement of the lower eyelid. Patients often have a wide stare and problems with dry eyes.

Xanthelasma: Appearance of yellowish fatty deposits over the upper and lower eyelids near the inner corners of the eye which can cause disfiguration.

EYELASH DISORDERS

Eyelashes are small hairs originating from the eyelashes. They prevent dust and debris from getting into the globe of our eyes. Disorders of the eyelashes include the following:

  • Madarosis: Loss or absence of eyelashes due to infection
  • Blepharitis: Inflammation of the eyelids leading to madarosis
  • Trichiasis: Malposition of the eyelashes where the eyelashes grow in towards the globe of the eye
  • Sty/hordeolum: Infection in the sebaceous gland of the eye present at the base of the eyelashes characterized by painful red bump on the eyelid

LAGOPHTHALMOS

Lagophthalmos is the inability to completely close eyelids. Lagophthalmic patients may have dry and irritated eyes due to exposure of the cornea (clear dome-shaped covering of the front of the eye) and excessive evaporation of the tear film. Some of the more serious complications of lagophthalmos include corneal ulceration and keratitis (inflammation of the cornea). Facial nerve paralysis (paralytic lagophthalmos) associated with Bell’s palsy is the main cause of lagophthalmos. Some of the other causes include trauma, infections, and tumors.

CHALAZION

A chalazion is a painless inflammation characterized by a lump or nodule formed on the upper or lower eyelid. A chalazion is non-communicable and usually does not affect vision, but a large lump can put pressure on the eye. 

Chalazion manifests as a painless, red, tender bump on the eyelid and causes excess tearing. It starts out very small, but can soon grow into a bump the size of a pea. Chalazion may cause blurred vision, due to pressure exerted on the eye by a large chalazion. Very rarely, they may indicate an infection or skin cancer.

A chalazion is caused due to a gland (the meibomian gland) present in the lining of the eyelids, which lubricates the eye surface. Blockage of these glands may result in the accumulation of oil in the gland until it eventually breaks open, releasing the oil into the neighboring tissue. This is what causes the inflammation.

Certain factors increase the risk of developing a chalazion. These include

  • Chronic blepharitis (inflammation of the eyelids or eye lashes)
  • Acne rosacea (redness due to blockage of blood vessels on the face)
  • Seborrhea (overactive sebaceous glands causing oily skin)
  • Tuberculosis
  • Viral infection

EYELID SWELLING

Eyelid swelling occurs due to inflammation or edema (fluid buildup) in the connective tissues surrounding the eye. It can be painful and is often accompanied by puffiness, itching, redness, and excessive tearing of one or both eyes. Some of causes that can lead to the swelling of the eyelids include allergies, conjunctivitis (pink eye), sty, chalazion, blepharitis, and trauma. Swelling of the eyelids can be a predecessor of more serious sight-threatening conditions and it is important that you contact your eye doctor without delay.

LID LAXITY

Lid laxity refers to loosening or slacking of the eyelids. Some of the causes include the natural ageing process, scarring from trauma or previous surgery, and facial paralysis. Lid laxity includes Ectropion, entropion, trichiasis, and floppy eyelid syndrome (upper eyelid is lax and easily everted).

LID TUMORS

Eyelid tumors

Hordeolum is an acute focal infection (usually staphylococcal) involving either the glands of Zeis (external hordeola, or styes) or, less frequently, the meibomian glands (internal hordeola).Hordeola are usually self-limited, spontaneously improving in 1-2 weeks.Internalhordeola may occasionally evolve into chalazia, which may require topical steroids, intralesional steroids, or surgical incision and curettage.

Chalazion (Greek for hailstone) is a lipogranuloma of either a meibomian gland or a Zeis gland. Conservative treatment with lid massage, moist heat, and topical mild steroid drops usually suffices. In resistant cases drainage by means of a transconjunctival incision and curettage is optimal.

Papilloma is any lesion on the eyelid that is papillomatous, that is, of smooth, rounded, or pedunculatedelevation.Surgical excision usually is a simple procedure for these benign skin lesions.

Basal cell carcinoma (BCC) is a nonmelanocytic skin cancer (ie, an epithelial tumor) that arises from basal cells (ie, small, round cells found in the lower layer of the epidermis). The prognosis for patients with BCC is excellent, but if the disease is allowed to progress, it can cause significant morbidity. In nearly all cases of BCC, surgery is the recommended treatment modality

Cutaneous squamous cell carcinoma (cSCC) is the second most common skin cancer, after basal cell carcinomas.Mohs micrographic surgery is indicated in Invasive cSCC.

Sebaceous cell carcinomas are typically found in women, more often in the seventh decade of life, and they usually are on the upper eyelid margin.Sebaceous tumors of the eyelid may arise from meibomian glands, Zeis glands, or glands associated with the caruncle. Biopsy specimen of the lesion establishes the diagnosis.The treatment of sebaceous gland carcinoma is adequate surgical excision, with wide surgical margins and fresh frozen section controls to delineate the tumor edges. If diffuse involvement of the upper and lower eyelids is present, exenteration is required.