Diseases of Eyelids
Eyelid diseases can affect the structure, function, and appearance of the eyelids, leading to discomfort, vision problems, or cosmetic concerns. Below are the definitions, causes, clinical features, investigations, and management of common eyelid disorders.
1. Ptosis
Definition: Drooping of the upper eyelid that partially or
completely covers the eye.
Causes
Congenital Due to levator muscle dysfunction or abnormal
development.
Acquired Neurogenic (e.g., third nerve palsy), myogenic (e.g.,
myasthenia gravis), aponeurotic (age-related), or mechanical (tumors).
Signs and Symptoms
- Drooping eyelid.
- Reduced visual field.
- Compensatory chin elevation or forehead wrinkling.
Investigations
- Clinical examination (levator function test, lid crease measurement).
- Neurological evaluation if neurogenic cause suspected.
- Imaging if tumors or trauma suspected.
Management
Congenital: Surgical correction (levator resection or frontalis
suspension).
Acquired: Treat underlying cause; surgery if severe.
2. Lagophthalmos
Definition: Inability to close the eyelids completely.
Causes
- Facial nerve palsy (e.g., Bell's palsy).
- Trauma or scarring of the eyelids.
- Thyroid eye disease.
Signs and Symptoms
- Incomplete eyelid closure.
- Exposure keratopathy.
- Dryness, redness, or irritation.
Investigations
- Schirmer's test for tear production.
- Slit-lamp examination to assess corneal damage.
Management
- Artificial tears and ointments.
- Eyelid taping or moisture chamber at night.
- Surgical options: lateral tarsorrhaphy or gold weight implantation.
3. Blepharitis
Definition: Chronic inflammation of the eyelid margins.
Causes
- Bacterial infection (e.g., Staphylococcus aureus).
- Meibomian gland dysfunction.
- Skin conditions (e.g., seborrheic dermatitis, rosacea).
Signs and Symptoms
- Red, swollen eyelids.
- Flaky or greasy debris on lashes.
- Burning, itching, or foreign body sensation.
Investigations
- Slit-lamp examination.
- Culture if infection suspected.
Management
- Warm compresses and lid hygiene.
- Topical antibiotics (e.g., erythromycin).
- Artificial tears for associated dryness.
4. Stye (External Hordeolum)
Definition: Acute bacterial infection of the eyelash follicle or
gland of Zeis.
Causes
Most commonly caused by Staphylococcus aureus.
Signs and Symptoms
- Painful, red swelling on the eyelid margin.
- Pus-filled lesion.
Investigations
Clinical diagnosis.
Management
- Warm compresses to promote drainage.
- Topical antibiotics if severe.
- Incision and drainage if large and persistent.
5. Chalazion
Definition: Chronic granulomatous inflammation of a Meibomian
gland.
Causes
Blockage of the small oil glands (Meibomian glands) ducts.
Signs and Symptoms
- Painless, firm nodule within the eyelid.
- No redness unless infected.
Investigations
Clinical diagnosis.
Management
- Warm compresses.
- Intralesional corticosteroid injection.
- Surgical excision if large or recurrent.
6. Internal Hordeolum
Definition: Acute infection of a Meibomian gland.
Causes
Most commonly caused by Staphylococcus aureus.
Signs and Symptoms
- Painful, swollen eyelid.
- Erythema and tenderness.
Investigations
Clinical diagnosis.
Management
- Warm compresses.
- Systemic antibiotics if cellulitis develops.
7. Trichiasis
Definition: Misdirection of eyelashes toward the ocular
surface.
Causes
- Chronic blepharitis.
- Trachoma.
- Scarring from trauma or surgery.
Signs and Symptoms
- Foreign body sensation.
- Corneal irritation or ulceration.
Investigations
Slit-lamp examination.
Management
- Epilation (lash removal).
- Electrolysis or cryotherapy for recurrent cases.
- Surgery if severe.
8. Entropion
Definition: Inward turning of the eyelid margin.
Causes
- Age-related (involutional).
- Scarring or spasm of eyelid muscles.
Signs and Symptoms
- Irritation and tearing.
- Corneal abrasion or ulceration.
Investigations
Clinical examination with external sign.
Management
- Lubricants for temporary relief.
- Botulinum toxin for spastic entropion.
- Surgical correction.
9. Ectropion
Definition: Outward turning of the eyelid margin.
Causes
- Age-related (involutional).
- Facial nerve palsy.
- Scarring or trauma.
Signs and Symptoms
- Tearing, redness, and irritation.
- Exposure keratitis.
Investigations
Clinical examination.
Management
- Lubricants and moisture shields.
- Surgical correction.
10. Blepharospasm
Definition: Involuntary contraction of the eyelid muscles.
Causes
- Essential (idiopathic).
- Secondary to irritation or neurological disorders.
Signs and Symptoms
- Frequent blinking or eyelid closure.
- Difficulty keeping eyes open.
Investigations
- Clinical examination.
- Neurological evaluation.
Management
- Botulinum toxin injections.
- Treat underlying causes if secondary.
15 Important Ques. and Ans.
1. What is ptosis?
Drooping of the upper eyelid.
2. What is the most common cause of a stye?
Staphylococcus aureus.
3. Name one investigation for lagophthalmos.
The patient should be observed for external signs such as incomplete blink, exophthalmos, eyelid malposition, degree of Bell's phenomenon.
4. What is the primary treatment for chalazion?
Warm compresses.
5. Define entropion.
Inward turning of the eyelid margin.
6. What is trichiasis?
Misdirection of eyelashes toward the cornea.
7. What is the treatment for blepharospasm?
Botulinum toxin injection.
8. What causes ectropion?
Age-related changes, facial nerve palsy.
9. Which gland is affected in a chalazion?
Meibomian gland.
10. What is the common cause of blepharitis?
Staphylococcus aureus.
11. What is the difference between stye and chalazion?
Stye is painful; chalazion is painless.
12. Name a complication of lagophthalmos.
Exposure keratopathy.
13. What is the management for trichiasis?
Epilation or cryotherapy.
14. What is the main symptom of blepharospasm?
Involuntary eyelid closure.
15. Name one surgical treatment for ptosis.
Levator resection.
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Disease