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The eyelids have many functions, including protecting
and lubricating the eye, producing oil secretions for the eye, and helping
to drain away tears. This page includes a variety of eyelid problems
ranging from lumps and bumps of the eyelid to twitching of the lid.
Eyelid malpositions (in-turning and out-turning) and drooping eyelids
(ptosis) are discussed as well. Other eyelid related problems that are
discussed on other pages of this Symptom and Diagnosis section are listed
below with possible distinguishing features.
For eye anatomy explanations, go to
||A chalazion, appears as a well defined
lump within the eyelid. The upper and lower eyelids each contain
about 30 oil secreting glands that open at the edge of the lid,
and travel deep within the plate of the eyelid. If one or more
of these glands becomes blocked, the gland continues to make
the secretion, but this is trapped within the lid and eventually
forms a rounded lump within the lid. There may be mild soreness
initially since the trapped material creates some inflammation
in the eyelid. The swelling may protrude toward the eye, toward
the outside and appear to be just under the skin, or protrude
at the edge of the eyelid. Conditions such as blepharitis and
rosacea may lead to chalazion formation.
In most cases, the chalazion will drain spontaneously if hot compresses
are applied to the eyelid a few times a day for a few days to a week.
Sometimes an antibiotic ointment or an oral antibiotic may help. In
cases where the chalazion does not drain, it can be drained surgically
under local anesthesia in the office. This procedure should not be
overdone, since it may lead to the loss of numerous glands in the
eyelid, which could lead to a dry eye problem in some people.
Sometimes a chalazion leads to the formation of a "granuloma",
which is a reactive fleshy growth on the inside of the eyelid. This
too can be removed if necessary. Lumps in the eyelid can put pressure
on the eye which can temporarily cause astigmatism, or a change
in the shape of the eye.
What is a hordeolum (stye)?
A hordeolum, also known as a
stye, is an inflammation of part of the eyelash. This condition is
seen more often in children than in adults. What
causes a stye? A
stye is caused by an infection in the sebaceous (oil producing) or
sweat glands in the eyelid. The infection is usually caused by
bacteria called Staphylococcus aureus. What
are the symptoms of a stye? The
following are the most common symptoms of a stye. However, each
child may experience symptoms differently. Symptoms may include:
- swelling of the eyelid
- redness at the edge of
- pain over the affected area
- Cellulitis is an infection of the eyelid, and is more severe than
the more low-grade "blepharitis",
which usually causes only itching or burning symptoms. Cellulitis
causes diffuse swelling of the entire eyelid, which is usually tender,
hot, and red. The swelling may extend onto the face, and there may
be discharge present. Cellulitis of the lower eyelid can mimic infection
of the tear drainage sac (dacryocystitis).
It is important to distinguish infection involving only the eyelid
from infection extending from behind the eye, or the orbit (orbital
cellulitis), which is usually more severe and causes eye protrusion
and double vision.
Eyelid cellulitis is treated with oral antibiotics, and sometimes
with IV antibiotics in more severe cases. It is important to watch
for extension of the infection into the orbit.
|Ectropion, or out-turning, of the eyelid usually
involves the lower eyelid. The lower eyelid pulls away from
the eye and visibly appears to sag down. Symptoms include irritation,
swelling, and redness of the eyelid, tearing, and irritation
and redness of the eye. The lower eyelid is usually pressed
flush against the eye and keeps the eye bathed in lubricating
tears. When the eyelid sags away, so do the tears, and the eye
can become severely dry. Tearing occurs if the opening in the
eyelid which drains tears away becomes separated from the eye.
Thus, tears have no way to drain away except onto the face.
Dryness of the cornea can lead to a scratchy sensation, redness
of the eye, pain, and blurred vision. Sometimes the cornea can
Most of the time, ectropion occurs along with the general aging changes
in the skin. The lower eyelid can become looser, and eventually pull
away from the eye by gravity. Bell's Palsy, or a temporary paralysis
of the side of the face, can suddenly make these normal aging changes
much worse, and the eye can become severely dry due to ectropion. Other
conditions lead to scarring of the skin under the eyelid, which pulls
the eyelid away from the eye.
Treatment of ectropion in some cases is merely to lubricate the
eye as best as possible, with artificial tears during the day and
ointment at night. In more severe cases, or if the cornea is at
risk due to severe dryness, the eyelid out-turning can be corrected
surgically under local anesthesia.
||Entropion, or in-turning, of the eyelid can involve
the upper or lower eyelid. Symptoms occur due to the scratching
of the eye by the inwardly pointing eyelashes (trichiasis).
Usually numerous eyelashes are involved, and it is impractical
to pull all of them. This condition can occur due to generalized
aging changing in the eyelid with a gradual rotation inward.
Other cases are caused by scarring, either from trauma, infection,
or an inflammatory condition such as shingles of the eyelid.
In cases where the eye is being severely scratched by the entropion,
surgery can be performed emergently to reposition the lid. Other less
severe cases might be able to be managed using lubricating eyedrops
and ointments on the eye, but usually surgery will need to be done.
|This discussion of eyelid tumors includes growths
present on the skin, the edge, or the inside surface of the
eyelid. A chalazion, or stye, which
is a lump within the eyelid, is covered in a section above.
Skin cancer of the eyelid appears usually as a
slowly enlarging lump usually on the lower eyelid. The most
common type is "basal cell" cancer, which usually
is a firm, pearly nodule which is non-tender. If present
at the edge of the eyelid, there may be a loss of eyelashes.
Another type of skin cancer of the eyelid resembles a chronic
infection of the lid, or blepharitis, with redness of the
lid. Melanoma can involve the outside or inside of the eyelid,
and usually is a changing, darkly pigmented growth. Sometimes
melanomas have no pigment.
Treatment of suspicious growths is by excisional biopsy with
examination in the laboratory to determine if the growth is
cancerous, and if it has been removed completely.
- Non-cancerous growths of the eyelid include:
- Skin tags or horns, which are fleshy growths of skin on
a stalk. These can be removed if necessary.
- Seborrheic keratoses, which are "stuck-on appearing"
growths on the skin. These are more of a cosmetic problem
and rarely have to be removed.
- Inclusion cysts, which are round, bubble-like swellings
on the eyelid which may come and go. If simply drained, they
- Viral papilloma, or wart-like growths, are fleshy growths
usually on the edge of the eyelid. These can be removed if
- Granulomas are inflammatory growths on the inside or outside
of the eyelid, and can occur after a stye, or chalazion.
- Molluscum contagiousum is a small viral growth of the
eyelid or skin which can spread. Usually it is a tiny, round,
white lump on the lid. Viral particles shed from this can irritate
the eye and lead to itching and redness. Treatment is by excision.
- Calcifications, or "concretions" can occur
on the inside of the eyelids. If the eyelid is flipped over, a
small, very white particle or cluster of particles may be seen
on the inside surface. Usually these are covered over by a transparent
membrane that lines the inside of the eyelid. Rarely do they erode
and scratch the eye, and rarely do they ever have to be removed.
- Twitching of the eyelid is a common, and annoying problem. Usually
a tiny piece of muscle beneath the skin of the upper or lower eyelid
seems to rhythmically and uncontrollably twitch. Often it is barely
visible to other people observing the eyes. The muscle fibbers beneath
the skin of the eyelid run in a circle around the eye, so the twitch
seems to also pull toward the inside or outside.
Causes include local eye irritation such as dry eye and blepharitis,
and artificial tears may help. Fatigue, stress, and lack of sleep
are other known causes. Stimulants such as caffeine and decongestants
may also lead to twitching. Rarely, pulsation of an artery on a
nerve controlling the muscle causes twitching.
Usually the eyelid twitching will resolve with time spontaeously.
A more severe version of this, called blepharospasm, leads to severe,
uncontrollable squeezing of the eyelids closed. This problem can
be treated if necessary by medication. This problem usually needs
evaluation by an ophthalmologist.
||Several problems can lead to drooping of the upper
eyelids, called ptosis (toe-sis). Some people are born with
this condition, and live their lives with no complaints or symptoms.
This may not even be a cosmetic problem, if it is symetrical
between the two eyes (as in some photos of Marilyn Monroe).
However, for people who develop worsening ptosis in one eye
or the other, it can become a battle to keep the eyes open.
Significant ptosis of the upper lids can block the upper field
of vision. Causes include:
- Aging changes - in some people the muscle that lifts the upper
eyelid slips back with time and the eyelid droops.
- Trauma - a blow to the eye or a laceration can damage or disinsert
the muscle controlling the height of the eyelid.
- Eye surgery - for an unknown reason, some people will develop
ptosis after catarct surgery, or other eye surgeries.
- Myasthenia gravis - this unusual disorder leads to temporary
often severe drooping of one eyelid. At other times, the height
of the lids can be completely normal. This may be associated with
muscle weakness and fatigue, and it is treatable with medication.
- Nerve paralysis - one of the nerves that control eye movement
also controls the muscle which lifts the eyelid. If the affected
eyelid is raised, usually the person will have double vision.
This is discussed more in the section on
paralysis. Another condition called "Horner's syndrome"
can cause this also, along with a small pupil on one side. Both
of these conditions need prompt evaluation by a ophthalmologist.
- Brow ptosis - in this condition, common in men, the entire brow
area drops down. If folds of skin then block the vision, surgical
correction can be done.
- Some people develop loose overhanging skin of the eyelids, or
develop pockets of fat which protrude and bulge in the eyelids.
This can be corrected surgically if necessary or desired.
Ptosis which encroaches on the pupil and is blocking the upper
field of vision can be surgically corrected. Less severe ptosis
can be corrected with cosmetic surgery.