19 Common Eyelid Disorders and their Treatment

The eyelids are an area of the body where a number of conditions can develop, including malignant ones. It is therefore important to maintain good hygiene measures in the area and to consult a physician when there are any abnormalities.
19 Common Eyelid Disorders and their Treatment

Written by Edith Sánchez

Last update: 26 September, 2022

Most eyelid disorders shouldn’t be a cause for concern. They are almost always problems that resolve on their own or can be addressed with pharmacology or surgical procedures.

The eyelids are a very sensitive area that we often don’t give enough attention. Whenever any abnormality in their shape or function is detected, it’s necessary to consult an ophthalmologist.

There are many different pathologies that afflict the eyelids and they have different origins. Sometimes they’re due to the action of internal factors, while others are the result of underlying conditions or environmental factors.

Common eyelid disorders

1. Hordeolum (styes)

Hordeolum (or styes) is one of the common eyelid disorders. It’s characterized by the appearance of a red bump on the edge of the eyelid. This is the result of a bacterial infection in a hair follicle, a sweat gland, or a sebaceous gland.

The stye can also be internal. In that case, it’s due to inflammation of the meibomian gland.

It almost always clears up on its own with time. However, it’s helpful to apply warm, moist compresses several times a day to the area. If it doesn’t resolve, antibiotics or incisional drainage may be needed.

2. Chalazion

A chalazion is a lump that forms under the skin of the eyelids. It’s caused by the blockage of the sebaceous glands, also known as Meibomian glands. When this occurs, oil accumulates and inflammation occurs resulting in this nodule or lump.

It usually hurts at first and the entire eyelid becomes swollen. Later, the swelling subsides and a painless lump remains.

In about 25% of cases, the chalazion disappears on its own without treatment. The application of warm compresses 3 or 4 times a day can help to unblock it.

It rarely becomes chronic and simply requires pharmacological treatment. If it doesn’t respond to this, the final option is surgical intervention.

A chalazion.
A quarter of the cases of chalazion resolve on their own so they don’t require a medical approach.

3. Eyelid edema

An eyelid edema or palpebral edema is an abnormal accumulation of fluid on the inner surface of the eyelid. It causes swelling and difficulty in opening the eye fully. It’s caused by trauma, conjunctivitis, sinusitis, allergy, or ocular herpes.

This disease causes pain, blurred vision, fever, tearing, and even blood in the eyes. Treatment depends on the cause.

Cold compresses and the use of artificial tears are usually recommended. Makeup shouldn’t be used and the eyes shouldn’t be rubbed.

4. Seborrheic keratosis

Seborrheic keratosis can occur anywhere on the body, including the eyelids. They are detached, serous, pigmented plaques. They’re usually small and appear more frequently in older people.

5. Actinic keratosis

Actinic keratosis is a flat, white, scaly lesion that can appear on the eyelids and other areas of the body. The surface of each lesion is rough, similar to sandpaper. It’s considered precancerous, as in 20% of cases it progresses to carcinoma.

It’s closely related to sun exposure, and, whenever this type of lesion is found, a biopsy should be performed.

Treatment consists of removing the tissue if it’s localized. If it covers a wide area of the eyelids, CO2 laser ablation is used.

6. Hydrocystoma

Hydrocystoma is a benign, light-colored cyst that appears on the edge of the eyelid. It’s usually translucent and is almost always due to obstruction of the sweat glands.

They’re more common on the lower eyelid. Treatment is surgical and consists of the complete removal of the cyst.

7. Molluscum contagiosum

Molluscum contagiosum is characterized by the presence of small serous nodules due to a viral infection. It usually appears in people who have a compromised immune system.

They sometimes cause inflammation of the hair follicles if they’re located near an eyelash. They usually disappear on their own. Otherwise, surgery must be done to remove them.

8. Nevus

Nevus looks like a growth very similar to moles. Sometimes they’re flat and sometimes raised.

They may or may not be pigmented. They don’t represent any danger and shouldn’t be treated, unless they change in size, color or shape.

If they do, it’s necessary to carry out tests on them and perhaps remove them by surgery.

Some nevus.
The control of nevus can be carried out with certain periodicity when there are fears they may be growing. This applies to any part of the body and not just the eyelids.

9. Xanthelasma

Xanthelasma is a small fatty lump under the skin of the eyelids. It’s usually yellowish in color.

It’s caused by high cholesterol or genetic factors, and can be removed by surgery or using carbon dioxide laser.

10. Eyelid retraction

Eyelid retraction or palpebral retraction occurs when one of the eyelids, the lower or upper one, is more open than normal. This abnormality is usually the result of a thyroid problem.

It affects the way the eyes open and close, making them less protected. If it’s in the upper eyelid, it’s usually treated with the application of botulinum toxin. If it’s in the lower eyelid, it usually requires surgery.

11. Coloboma

Coloboma occurs when part of the upper or lower eyelid is missing. This condition is present at birth and can affect both eyes or just one eye.

If left untreated, it causes vision problems and dry eye syndrome. In most cases, it can be addressed by surgery.

12. Blepharitis

Blepharitis is one of the most common diseases of the eyelids. It’s the inflammation of the edge of the eyelids, right where the eyelashes come out. It causes the following:

  • Stinging
  • Itching
  • Morning itching
  • Redness
  • Styes and chalazions

This pathology is chronic and is caused by the presence of parasites, bacterial infections, or dryness in the eye. It can also be caused by other problems, such as rosacea.

Daily eyelid hygiene is the best treatment. Sometimes antibiotic ointments or tablets are used if there is bacterial overgrowth.

13. Meibomianitis

Meibomianitis is also known as posterior blepharitis. It occurs when the sebaceous glands at the base of the eyelashes become clogged.

This leads to the eyelids forming a crust, which obstructs vision. It’s treated with surgery and you apply the same measures as for blepharitis.

14. Blepharospasm

Blepharospasm is an involuntary contraction of the eyelids that causes continuous blinking, twitching, or repeated fluttering. It tends to affect people with high levels of stress more, as well as those who don’t sleep well.

It can be of two types:

  • Benign essential blepharospasm (BEB): This affects both sides of the face. It’s due to a malfunction of the basal ganglia. If aggravated, it can render a person blind. It’s treated with medications, including botulinum toxin injections.
  • Hemifacial blepharospasm occurs on only one side of the face. It’s usually due to irritation of the nerves of the face. A brain MRI is recommended in these cases.

15. Drooping eyelid or palpebral ptosis

Also known as blepharoptosis. It occurs when the upper eyelid droops. If this is very pronounced, it blocks the pupil and causes partial blindness.

Depending on the cause, there are several types:

  • Congenital: Resulting from an abnormal development of the levator muscle. It may cause lazy eye or permanent vision loss. It’s corrected by surgery.
  • Aponeurotic: This comes from aging, gravity, and repeated movement. It’s treated with surgery.
  • Myasthenia gravis: This causes progressive muscle weakness in the face and other parts of the body. It may be corrected with surgery.

Other causes are trauma, eyelid infections, nerve damage from diabetes, congenital muscle disease, a tumor, or brain aneurysm.

Droopy eyelid.
A droopy eyelid (myasthenia gravis) is one of its characteristic signs and often the clue to the diagnosis.

16. Dermatochalasis

Dermatochalasis occurs when excess eyelid skin or fat hangs over the edge of the eye, obstructing vision. It’s usually the effect of the aging process or the displacement of fat hernias in the eyelid.

It’s corrected by surgical intervention.

17. Ectropion and entropion

Ectropion and entropion are alterations in the normal position of the eyelids in relation to the eyeball. They’re due to a loss of tension in the tendon that supports the eyelid or lateral canthal tendon.

They can only be eradicated by surgical intervention. Each of these conditions involves a different abnormal position:

  • Ectropion: The eyelid is positioned outward, exposing the conjunctiva. The conjunctiva becomes reddish with time and may keratinize, causing the eye to become unlubricated.
  • Entropion: The eyelid is positioned inward and may cause the eyelashes to rub against the cornea. It can lead to corneal injury.

18. Trichiasis and distichiasis

Trichiasis and distichiasis are diseases that cause abnormal growth of the eyelashes. In both cases, surgical intervention is required to correct the problem, which can be by cryosurgery, electrolysis, or repositioning surgery.

The difference between one and the other is the following:

  • Trichiasis: Characterized by the eyelashes growing inward toward the eye. This causes them to rub against the cornea and conjunctiva, generating continuous irritation.
  • Distichiasis: yThis is when eyelashes grow in places where they shouldn’t normally be. Sometimes a second line of eyelashes even appears.

19. Cancer

The eyelids can also be affected by cancer. There are different types:

  • Basal cell carcinoma: This is the most common and usually appears on the lower eyelid. It looks like a firm, pearly nodule. It must be removed and, in some cases, requires adjuvant radiation.
  • Squamous cell carcinoma is less common, but more aggressive. It usually forms on the upper eyelid, and often begins as an actinic keratosis.
  • Sebaceous carcinoma: This is similar in appearance to a chalazion or blepharitis. It’s very aggressive and the larger it is, the more dangerous it is. It’s more common in older or middle-aged people. and is treated with surgical removal and radiotherapy.
  • Melanoma: This is a pigmented tumor that appears in the eyelids and very often metastasizes, even if it’s small.

Good hygiene

Many diseases of the eyelids remit on their own. Even so, whenever an abnormality is detected in this area, it’s important to consult a doctor.

The best thing to do is to maintain good hygiene. Washing twice a day with warm water helps prevent many problems. Early treatment of eyelid diseases will always produce the best results.

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