An eyelid disorder is any abnormal condition that affects the eyelids.
Eyelids consist of thin folds of skin, muscle, and connective tissue. The eyelids protect the eyes and spread tears over the front of the eyes. The inside of the eyelids are lined with the conjunctiva of the eyelid (the palpebral conjunctiva), and the outside of the lids are covered with the body's thinnest skin. Some common lid problems include the following: stye, blepharitis, chalazion, entropion, ectropion, eyelid edema,and eyelid tumors.
Dermatochalasis commonly affects the elderly, although sometimes it is congenitally acquired. The elderly version may begin to develop as early as 40 years of age, and it continues to progress with age.The congenital version may begin around 20 years of age. There is no racial predisposition towards developing dermatochalasis, and men and women are equally affected.
Dermatochalasis is caused by a loss of elasticity in the connective tissue supporting the structure of the front portion of the eyelid. Normally, in Caucasians, the orbicularis muscle and overlying skin form a crease near the tarsal border. In dermatochalasis, the excess tissues hangs down, over the front edge of the eyelid. The excess tissue can sometimes obstruct the visual field, especially the superior visual field. In severe cases, it may obstruct as much as 50 percent of the superior visual field.
If dermatochalasis is severe enough to obstruct the peripheral or superior visual fields, then it may be treated with a surgical procedure called blepharoplasty. In blepharoplasty surgery, excess skin, muscle and fat are removed. While the improvement of vision is an indication for blepharoplasty on the superior eyelid, if the visual fields are not obstructed, it may be performed for cosmetic reasons. In general, blepharoplasty of the inferior eyelid is considered cosmetic, as dermatochalasis in the lower eyelid does not interfere with vision.
Patients with dermatochalasis often also have blepharitis, a condition caused by the plugging of glands in the eye that produce lubricating fluid (meibomian glands). Dermatochalasis can be severe enough that it pushes the eyelashes into the eye, causing entropion.
Weakness in the orbital septum may cause the herniation of the orbital fat pads. This is observed as the presence of bulges (fat pads) in the soft tissue of the baggy eyes
A stye is an infection of one of the three types of eyelid glands near the lid margins, at the base of the lashes.
Styes are usually caused by bacterial staphylococcal infections. The symptoms are pain and inflammation in one or more localized regions near the eyelid margin. Styes are treated with warm compresses for 10-15 minutes, three to four times a day. Chloramphenicol ointment may be used as well. Sometimes topical antibiotics may be prescribed if the infection is spreading.
Chalazion A chalazion is an enlargement of a meibomian gland (an oil-producing gland in the eyelid), usually not associated with an infectious agent. More likely, the gland opening is clogged. Initially, a chalazion may resemble a stye, but it usually grows larger. A chalazion may also be located in the middle of the lid and be internal. A chalazion is caused by a blockage in the outflow duct of a meibomian gland. Symptoms are inflammation and swelling in the form of a round lump in the lid that may be painful.
About 25% of chalazia will disappear spontaneously, but warm compresses may speed the process. Chloramphenicol ointment may be used as well. Because chalazia are inside the lid, topical medications are generally of no benefit. Medication may need to be injected by the doctor into the chalazion or if that doesn't help the chalazion may need to be excised. If what appears to be a chalazion recurs on the same site as any previous one, the possibility of sebaceous gland carcinoma should be investigated by biopsy.
Blepharitis is the inflammation of the eyelid margins, often with scales and crust. It can lead to eyelash loss, chalazia, styes, ectropion, corneal damage, excessive tearing, and chronic conjunctivitis.
Some cases of blepharitis are caused by bacterial infection and some by head lice, but in some cases, the cause is unclear. It may also be caused by an over-production of oil by the meibomian glands. Blepharitis can be a chronic condition that begins in early childhood and can last throughout life. Symptoms can includeitching, burning, a feeling that something is in the eye, inflammation, and scales or matted, hard crusts surrounding the eyelashes.
Blepharitis is treated with hot compresses, with antibiotic ointment, and by cleaning the eyelids with a moist washcloth and then with baby shampoo. Good hygiene is essential. Patients can try to keep rooms dry, such as by placing a bowl of water on top of a radiator. Tear film supplements such as hypromellose can help moisten the eyes when dry. If itching, soreness, or redness occurs from the tear film drops, they should be stopped. Topical or systemic antibiotics also may be prescribed. If the blepharitis doesn't clear up with treatment or if it seems to be a chronic problem, the patient may have acne rosacea. These patients may need to see a dermatologist as well.
Entropion is a condition where the eyelid margin (usually the lower one) is turned inward; the eyelashes touch the eye and irritate the cornea. Entropion usually results from aging, but sometimes can be due to a congenital defect, a spastic eyelid muscle, or a scar on the inside of the lid from surgery, injury, or disease. It is accompanied by excessive tearing, redness, and discomfort.
Ectropion is a condition where one or both eyelid margins turn outward, exposing both the conjunctiva that covers the eye and the conjunctiva that lines the eyelid. Similar to entropion, the usual cause of ectropion is aging. It also can be due to a spastic eyelid muscle or a scar, as in entropion. It also can be the result of allergies. Symptoms are excessive tearing and hardening of the eyelid conjunctiva.
Both entropion and ectropion can be surgically corrected. Prior to surgery, the lower lid of entropion can be taped down to keep the lashes off the eye, and both can be treated with lubricating drops to keep the cornea moist.
Eyelid edema is a condition where the eyelids contain excessive fluid. Eyelid edema is most often caused by allergic reactions, for example, allergies to eye makeup, eyedrops or other drugs, or plant allergens such as pollen. Trichinosis, a disease caused by eating undercooked meat, also causes eyelid edema. However, swelling can also be caused by more serious causes, such as infection, and can lead to orbital cellulitis which can threaten vision. Symptoms can include swelling, itching, redness, or pain.
Patients with swollen eyelids should contact their eye doctor. A severely swollen lid can press on the eye and possibly increase the intraocular pressure. An infection needs to be ruled out. Or, something as simple as an allergy to nail polish and then touching the eyes can cause swelling. The best treatment for allergic eyelid edema is to find and remove the substance causing the allergy. When that is not possible, as in the case of plant allergens, cold compresses and immunosuppresesive drugs such as corticosteroid creams are helpful. However, steroids can cause cataracts and increase intraocular pressure and patients must be very careful not to get the cream in their eyes. This should not be done unless under a doctor's care. For edema caused by trichinosis, the trichinosis must be treated.
Eyelid tumors Eyelids are susceptible to the same skin tumors as the skin over the rest of the body, including noncancerous tumors and cancerous tumors (basal cell carcinoma, squamous cell carcinoma, malignant melanoma, and sebaceous gland carcinoma). Eyelid muscles are susceptible to sarcoma.
Tumors found on the eyelids are caused by the same conditions that cause these tumors elsewhere on the body. They are usually painless and may or may not be pigmented. Some possible causes include AIDS(Kaposi's sarcoma) or increased exposure to ultraviolet (UV) rays which may lead to skin cancer. Cancerous tumors should be removed upon discovery, and noncancerous tumors should be removed before they become big enough to interfere with vision or eyelid function. Eyelid tumors require special consideration because of their sensitive location. It is important that treatment not compromise vision, eye movement, or eyelid movement. Accordingly, eyelid reconstruction will sometimes accompany tumor excision.
Prevention Good lid hygiene is very important. Regular eyelid washing with baby shampoo helps prevent styes, chalazia, blepharitis, and eyelid edema. To avoid these problems, it's also important to refrain from touching and rubbing the eyes and eyelids, especially with hands that have not just been washed.
Blepharitis is associated with dandruff, which is caused by a kind of bacteria that is one of the causes of blepharitis. Controlling dandruff by washing the hair, scalp, and eyebrows with shampoo containing selenium sulfide to kill the bacteria helps control the blepharitis. When using anything near the eyes, it is important to read the label or consult with a doctor first.
Avoiding allergens helps prevent allergic eyelid edema. Staying inside as much as possible when pollen counts are high and eliminating the use of, or at least removing eye makeup thoroughly, or using hypoallergenic makeup may help if the person is sensitive to those substances.
Sunscreen, UV-blocking sunglasses, and wide brimmed hats can help prevent eyelid tumors.
Entropian and ectropian seem to be unpreventable.
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