Eyelid Disorders
Eyelid Disorders
There are a variety of conditions affecting the eyelids.
- Blepharitis / Meibomitis
Blepharitis, a very common lid problem refers to inflammation of the eyelids, seen as red and crusty lids, with symptoms which may include: itchiness, red / watery eyes, swollen lids, gritty / burning sensation, crusty / flaky lids.
Meibomitis refers to inflammation of the meibomian glands, which are a row of glands within the tarsus of the eyelid. They produce an oily secretion (meibum) which is an essential component of the tear composition. Inflammation leads to disruption of secretion and affects the stability of tear film resulting in so called dry eye, otherwise known as keratoconjunctivitis sicca. Sometimes when the orifice of the gland gets blocked, a cyst forms ie chalazion, which may be asymptomatic and un-inflamed or become inflamed and possibly infected.
Once identified, the simplest approach is the perform warm compresses followed by lid scrub. The reason of applying warm/hot compresses is to soften the dried skin debris along the lids, to soften the oily secretions along the meibomian gland openings so that it flows more freely as well as trying to unblock the blocked gland orifices. One simply soaks a small flannel, or use a couple of cotton balls, or a cosmetic eye-pad in hot water, then apply onto the closed lids for several minutes. When cooled, re-soaked and re-apply. One may perform this over several minutes.
With lid scrub, in a small cup (eg one of those plastic medicine measuring cup) filled with warm/hot water, add a decent pinch of sodium bicarbonate (easily found in most kitchens) or add a few drops of Johnson Baby shampoo; moisten a cotton bud with the solution and gently scrub along the eyelid margin to remove any skin / oily debris. There are commercial preparations available from the local chemist such as SteriLid which may suit some.
Depending on the extend of the problem, one may perform this as many times as necessary!
The following links provide useful information for those who seek more explanations.
https://www.aao.org/eye-health/diseases/what-is-blepharitis
https://www.aao.org/eye-health/diseases/what-are-chalazia-styes
https://eyewiki.aao.org/Meibomian_Gland_Dysfunction_(MGD)
https://ranzco.edu/wp-content/uploads/2019/06/OPA-RANZCO-Blepharitis-ed2-3.pdf
In some patients, with persisting meibomitis which may be related to an underlying skin condition known as acne rosacea, sometimes topical antibiotic ointment and oral antibiotic may be prescribed. It is best that you consult with your GP first.
- Ectropion / Entropion
Ectropion refers to eversion or out-turning of the lower eyelid. Normally the lower eyelid is held in a stable position by various components including the medial and lateral canthal tendon, and the inferior retractor. Weakening of any of these supporting structures may lead to ectropion and it is important to address the relevant structure surgically. The other cause is from long term sun-damaged skin causing tightening and contracture of the lower lid skin, pulling it outwards ie cicatricial ectropion which requires surgical repair with a skin graft
https://eyewiki.aao.org/Ectropion
- Entropion
Entropion refers to in-turning of the eyelid and regardless of underlying cause, the result is constant irritation of the eye from the in-turned eye lashes with watery, irritable eye. One needs to assess the integrity of the lid supporting structures and repair surgically. The link below direct those who seek further information and should you have a concern, please address this with your GP first.
- Ptosis
Or droopy lid, is due to weakening of the muscle (levator palpebral superioris) which elevates the upper lid. Often with aging, the attachment weakens resulting in a droopy lid (involutional ptosis). Depending on the severity, surgical correction under local anaesthetic is performed. It is important to assess the problem carefully and exclude other causes, as the treatment may well be not surgical but medical eg myasthenia gravis.
Pre-surgery, left ptosis repair
Post-surgery, 10 days
- Lid tumour
Lesions affecting the lid skin are varied and can be either benign or malignant. Common benign lid tumour include papilloma, molluscum contagiosum, trichoepithelioma, xanthelasma, sebaceous cyst to name a few. Some is easily recognized without the need for biopsy and dealt with by local resection, extirpation and cautery under local anaesthetic.
Malignant skin tumours include:
- Basal cell carcinoma (BCC), most common, locally invasive, does not metastasize
https://eyewiki.org/Basal_Cell_Carcinoma
Nodular BCC
Post-excision with skin graft
- Squamous cell carcinoma (SCC), less common, often arise from a precancerous dermatosis and can spread to regional lymph nodes.
https://eyewiki.org/Squamous_Carcinoma_of_the_Eyelid - Sebaceous cell carcinoma, least common arising from meibomian glands and can be a great mimicker, often diagnosed late and has poor prognosis
https://eyewiki.org/Sebaceous_carcinoma
The links provide additional information for those interested to read further. Any concern of suspicious lesion(s), you should always consult your GP first.
A collection of several lid lesions below
