Eyelid Disorders

Table of contents
Key points ⚡
Succinct notes to superpower your revision
Eyelid disorders\: Common in primary care; some can risk sight loss and require ophthalmology referral. Eyelids prevent
eye drying and protect from foreign bodies and excessive light.
Blepharitis\: In
sensation, burning, redness, crusting. Causes\: atopic dermatitis, seborrheic dermatitis, acne rosacea, Demodex mites.
Treatment\: lid hygiene (warm compress, eyelid massage, cleaning), topical antibiotics (chloramphenicol), low-dose oral
tetracyclines, omega-3 supplements.
Hordeolum (stye)\: Staphylococcal infection of an eyelash follicle (external) or meibomian gland (internal). Presents as
tender, red eyelash follicle swellings.
Treatment\: warm compress, eyelash removal, incision with a sterile needle, topical/oral antibiotics if recurrent or severe.
Chalazion\: Non-infectious granulomatous in
associated with blepharitis and acne rosacea.
Treatment\: warm compress, eyelid massage. Persistent cases require ophthalmology referral for incision and curettage.
Entropion\: Inward turning of the eyelid, leading to corneal irritation and potential ulceration. Causes\: age-related changes,
eyelid irritation, scarring, trachoma.
Treatment\: examine for corneal abrasions/ulcers, prescribe lubricants, advise eyelid taping, refer for surgical correction.
Ectropion\: Outward turning of the eyelid, often due to age-related changes or facial nerve palsy (Bell’s palsy). Presents with
a sore, red, watery eye due to disrupted tear drainage.
Treatment\: lubricating eye drops, taping eyes shut at night, corrective surgery for severe cases. Urgent referral for exposure
keratopathy.
Trichiasis\: Inward-growing eyelashes due to damaged follicles, causing corneal irritation and potential ulceration. Often
due to chronic blepharitis.
Treatment\: epilation of eyelashes, electrolysis, or laser ablation for more permanent solutions. Examine for corneal damage.
Article 🔍
A comprehensive topic overview

Introduction

Eyelid disorders are a common presenting complaint in primary care. Although most eyelid conditions can be managed
conservatively, some risk sight loss and require referral to ophthalmology.
Eyelids comprise skin, muscle, connective tissue, glands and conjunctiva. They have an important role in preventing the
eye from drying out and help protect the eye from foreign bodies and excessive light.
Meibomian glands are in the posterior aspect of the eyelid (Figure 1). They are modi
the lipid outer layer of the tear
each eyelid.Figure 1. Eyelid anatomy.
1
Eyelashes are in the anterior aspect of the eyelid and help prevent foreign bodies from entering the eye. Each eyelash
follicle is associated with sweat and sebaceous glands.

Blepharitis

Blepharitis is in
ophthalmology-related presentations in primary care.
2
Patients typically present with bilateral symptoms of ocular irritation, foreign body sensation, burning, redness and
crusting. There may be paradoxical watering of the eye due to re
Although the exact aetiology of blepharitis is unclear, the underlying disease process involves congestion and
in
Causes of blepharitis include\:
Atopic dermatitis (staphylococcal)
Seborrheic dermatitis
Acne rosacea
Demodex infestation (mites)
Blepharitis commonly presents with appears as erythematous and thickened eyelid margins. The base of eyelashes may
reveal crusting (Figure 2). and matting. Immediately posterior to the eyelashes, yellow ‘capping’ of meibomian gland
ori
Figure 2. Blepharitis with eyelash crusting.
3Figure 3. Blepharitis.
4
Lid hygiene is important for treating and preventing blepharitis.
There are three steps to cleaning eyelids that should be performed at least once a day\:
Warm compression of the eyelids with a warm compress to loosen debris
Eyelid massage to empty glands of debris
Cleaning eyelids with cotton wool to remove debris
Topical antibiotic ointments (e.g. chloramphenicol) can be applied to the eyelid margin for a few weeks to reduce bacterial
colonisation.
An extended course of low-dose oral tetracyclines and regular omega-3 fatty acid supplements may have a useful anti-
in

Hordeolum

An external hordeolum is caused by a staphylococcal infection of an eyelash follicle. External hordeolum tend to a
children and young adults and are also known as a stye.
An internal hordeolum is an infection of a meibomian gland and is far less common.
External hordeola present as tender, red eyelash follicle swellings (Figure 4).
Figure 4. External hordeolum.
5
Hordeola often resolve spontaneously. Patients should be encouraged to perform warm compression of the eyelid
multiple times a day to reduce swelling.
Other treatment options include\:
Removal of the eyelash associated with external hordeolum
Incision of the hordeolum with a
Topical antibiotics (e.g. chloramphenicol) or oral antibiotics (e.g. co-amoxiclav) if the hordeolum is recurrent or severeChalazion
A chalazion is a granulomatous in
Unlike hordeola, chalazion are non-infectious. Chalazion are often associated with blepharitis and acne rosacea.
Chalazia present as painless red eyelid cysts in the internal eyelid (Figure 5). If chalazia are infected, they become internal
hordeolum.
Figure 5. Chalazion.
6
Figure 6. Chalazion with eye closed.
7
A chalazion and external hordeolum can be easily distinguished as chalazia are not painful or tender to touch. In contrast,
an external hordeolum is associated with pain (i.e.
‘styes sting’).
Chalazia often resolve spontaneously. Patients should be encouraged to perform warm compression of the eyelid (to
loosen meibomian gland content) and eyelid massage (to express meibomian gland content) twice a day.
A persistent chalazion requires referral to ophthalmology for consideration of incision and curettage.Entropion
Entropion is inward turning of the eyelid. Inward-turning eyelashes may irritate the cornea causing ulceration and risking
sight loss.
The most common cause is age-related degenerative changes to the lower eyelid. Entropion can also be caused by
eyelid irritation or scarring. Trachoma (a bacterial eye infection caused by C h l a m y d i a t r a c h o m a t i s ) is a common cause of
entropion in places that have limited access to sanitation and water.
The management of entropion includes\:
Examination for corneal abrasions and ulcers (keratitis)
Patients should be prescribed frequent lubricants to reduce the risk of corneal abrasions and advised on how to perform
eyelid taping as a temporising measure
Referral to ophthalmology for surgical correction

Ectropion

Ectropion is an outward turning of the eyelid.
Ectropion is mostly caused by age-related degenerative changes to the lower lid and presents with a sore red eye. The
eye is often watery due to disrupted tear drainage.
Another common cause is facial nerve palsy (Bell’s palsy) which concurrently causes incomplete upper eyelid closure.
This is a risk factor for the development of exposure keratopathy, which is damage to the cornea due to ocular dryness
caused by inadequate lid closure. 8
Exposure keratopathy can cause sight loss.
The management of ectropion is typically conservative with lubricating eye drops and taping the eyes shut at night.
Severe cases may require corrective surgery.
Patients should be referred to ophthalmology urgently if there are any features of exposure keratopathy (clinical features
are similar to a corneal abrasion).

Trichiasis

Trichiasis is when eyelashes grow inwards due to damaged eyelash follicles. Inward-growing eyelashes may irritate the
cornea causing corneal ulceration and risking sight loss.
Most cases of trichiasis are caused by eyelid in
When assessing trichiasis, it is important to examine for evidence of corneal damage.
Trichiasis can be treated by epilating the eyelash however recurrence may occur within a few weeks. Electrolysis or laser
ablation can destroy the lash follicle and may provide a more permanent solution.

References

Henry Vandyke Carter (modiLINK]
NICE CKS. B l e p h a r i t i s . Published in 2019. Available from [LINK]
Clubtable (Wikipedia user). B l e p h a r i t i s . License\: [Public domain]. Available from\: [LINK]
Imran Kabir Hossain. A n t e r i o r b l e p h a r i t i s. License\: [CC BY-SA]. Available from\: [LINK]
Andre Riemann. H o r d e o l u m e x t e r n u m . License\: [Public domain]. Available from\: [LINK]
Michal Klajban. C h a l a z i o n . License\: [CC BY-SA]. Available from\: [LINK]
Poupig (Wikipeida user). C h a l a z i o n . Licence\: [CC BY-SA]. Available from\: [LINK]
Wanjiku Mathenge. E m e r g e n c y m a n a g e m e n t \: E x p o s u r e k e r a t o p a t h y . Published Mary Lowth. C h a l a z i o n . Published in 2016. Available from\: [LINK]
2018. Available from\: [LINK]Mary Lowth. C o n d i t i o n s A LINK]
Mary Harding. B l e p h a r i t i s . Published in 2014. Available from\: [LINK]
Mostafa Khalil, Omar Kouli. T h e D u k e E l d e r E x a m O f O p h t h a l m o l o g y \: A C o m p r e h e n s i v e G u i d e f o r S u c c e s s . in 2020.
Book published
The College of Optometrists. C l i n i c a l M a n a g e m e n t G u i d e l i n e s . Published in 2018-2020. Available from\: [LINK]

Reviewer

Dr Sahib Tuteja
Opthalmology trainee

Related notes

Acute Angle-Closure Glaucoma
Age-related Macular Degeneration (ARMD)
Amblyopia
Ametropia
Anisocoria

Test yourself

Contents

Introduction
Blepharitis
Hordeolum
Chalazion
Source\: geekymedics.com