Definition and Overview
The eyelids are the natural skinfolds that are found above and below the eyes. At the edge of the eyelids are the eyelashes (sometimes abbreviated as the lashes), which are natural hairs. Both the eyelids and eyelashes protect the eyes from foreign matter including but not limited to sweat and dust that can irritate the eyes or affect the person’s vision. They also keep the eyes moist by helping spread the tears produced by the ducts when you blink. Further, the eyelids control the amount of light that hits the eyes so glare, which can cause eye strain and headaches, is minimized.
Because of the proximity of the eyelids to the lashes and the eyes themselves, medical conditions that are eyelid related can also have an impact on these two.
Causes of Conditions
Below are the common eyelid problems and their causes:
Ptosis - Also referred to as droopy eyelids, this condition is characterized by the heavy skin folds of the upper eyelid. The degree of the fold can vary. In many cases, it is mild that no intervention is necessary. However, when it is severe, it can significantly reduce or even totally block the patient’s vision. Ptosis can be caused by several factors including aging, in which the skin starts to lose collagen and begins to wrinkle. It can also be congenital or form during conception or caused by injuries.
Ectropion and Entropion - This refers to the unusual position of the eyelids. It’s considered entropion when it develops inward and ectropion when it’s outward. The biggest reason for this is aging, which leads to loss of skin elasticity. These can be a problem since they can expose the eyes to irritants, and lashes themselves can cause irritation to the eyes, particularly the cornea.
Cysts - The eyelids can also appear swollen due to the formation of cysts underneath. Similar to the formation of acne, the cysts may develop because of a blockage in the eyelids. Sometimes they become severe that the cyst can become infected. However, it is very rare that the cysts or lumps are malignant or cancerous.
Stye – This is an inflammation that is observed near the lashes and at the tip of the eyelids. It develops due to a bacterial infection that occurs in the glands.
There are also times when the eyelid problems are linked to an underlying condition. Including the following:
The formation of a mole around the eyelids which could be a sign of skin cancer or melanoma, which is the most serious type of skin cancer.
Conjunctivitis - also known as a pinkeye, is an inflammation of the conjunctiva, a layer of a very thin tissue that covers the front of the eyes. One of its symptoms is increased tearing, which can then result to sticky eyelids.
Eczema - this refers to a group of medical conditions that affect the skin, which can occur due to inflammation. Its main characteristics are flaky and itchy skin, which may also affect the eyes
Allergic rhinitis - this can also increase tearing, causing itchy or sticky eyelids.
- Itchiness and flakiness in the eyelids
- Swelling of the eyelids
- Redness of the eyes
- Formation of a cyst or lump
- Increased tearing
- Reduced or blurry vision
- Eye pain
- Eyelash loss
- Constant breakage of the eyelashes
Who to See and Treatments Available
Many of the eyelid problems are common, and the majority of them are treated by general practitioners including family doctors. However, severe cases are handled by ophthalmologists -- medical professionals who specialize in eye diseases. An ophthalmologist is different from an optometrist, in that the latter deals mostly with refractive errors like nearsightedness, farsightedness, and astigmatism.
The general consultation would involve a physical exam, including close inspection and evaluation of the eyelids, the eyes, and the lashes. The doctor would also review the patient’s medical history and activities prior to the development of the disease to understand the possible cause of the condition. It’s rare to conduct more complicated exams.
In some cases, eyelid problems clear out on their own. Otherwise, they are treated using the following methods:
Surgery – An eyelid surgical procedure called blepharoplasty is often recommended when there are physical changes in the eyelids. Such as in cases where they have become severely droopy or have turned inward or outward. During the surgical procedure, the surgeon removes the fatty tissue that may be causing the problem. This surgery is also an elective procedure taken advantage of by people with small eyes since it makes the eyes appear larger.
Ointments and drops – The drops or ointments may be given if the problem isn’t severe. These are prescribed to relieve pain, minimize symptoms such as itchiness, dryness, and redness, as well as increase the level of visual comfort.
Antibiotics – These are recommended if the cause of the problem is a bacterial infection.
Treatment of the underlying disease - If the eyelid problem is caused by an underlying or existing condition, the treatment will focus on resolving the disease. For instance, if the patient is experiencing excessive tearing due to allergic rhinitis, antihistamines can be prescribed to cure both the underlying disease and the eyelid problem.
Kostick DA, Bartley GB. Upper eyelid malpositions: congenital ptosis. In: Albert DM, Miller JW, Azar DT, Blodi BA, Cohan JE, Perkins T. Albert & Jakobiec's Principles & Practice of Ophthalmology. 3rd ed. Philadelphia, PA: Elsevier Saunders; 2008:chap 256.
Olitsky SE, Hug D, Plummer LS, Stass-Isern M. Abnormalities of the lids. In: Kliegman RM, Behrman RE, Jenson HB, Stanton BF, eds. Nelson Textbook of Pediatrics. 19th ed. Philadelphia, PA: Elsevier Saunders; 2011:chap 616.