Eyelid problems explained

Finding the right guide

Most eyelid problems fall into a few broad groups: eyelids that droop or sit in the wrong position, the irritation and twitching that come from the eyelid margin and its glands, the various lumps and cysts that can appear, and, less commonly, skin cancers that can develop on the delicate eyelid skin. If you are not sure which applies to you, the descriptions below should help you find the most useful guide. None of these pages can replace a face-to-face examination, but they will help you understand what you are dealing with and what can be done.

What your eyelids actually do

It is easy to think of the eyelids as little more than a cover that opens and closes, but they do a great deal of quiet work. Every time you blink, the upper lid sweeps a fresh layer of tears across the surface of the eye, in much the same way that a windscreen wiper draws a film of water across glass. That single blink does three things at once: it keeps the surface moist, it smooths the optical surface so that your vision stays sharp, and it pushes older tears towards the drainage openings at the inner corner. The lid margins also carry a row of small oil glands whose secretion stops the tear film evaporating too quickly. When the eyelids are working well you are completely unaware of them, which is exactly as it should be.

This is why eyelid problems so often reach beyond appearance. An eyelid that sits a little too low, turns slightly outward, or loses the quality of its oil can affect comfort, the health of the eye surface, the drainage of tears, and sometimes vision itself. A small change in the position or function of an eyelid can have an effect out of all proportion to its size, which is part of why these conditions are worth understanding and, in the great majority of cases, well worth treating.

Eyelids that droop or sit out of position

With age the supporting tissues of the eyelid gradually loosen. The upper lid may begin to droop down over the eye, a condition called ptosis, or the skin of the upper lid may become heavy and hooded, which is known as dermatochalasis. The lower lid can turn outward, away from the eye, called ectropion, or inward so that the lashes rub against the surface, called entropion. Some of these changes are purely a matter of appearance, while others affect the field of vision or the comfort and health of the eye. The distinction matters a great deal, because it usually determines both the right operation and whether treatment is considered medical or cosmetic.

Irritation and twitching at the lid margin

The edge of the eyelid, where the lashes emerge, is a common source of trouble. Blepharitis, a long-term inflammation of the lid margin and its oil glands, is one of the most common eye conditions I see in clinic, and one of the most frequently missed. It tends to cause burning, grittiness, crusting first thing in the morning, and, surprisingly to many people, watering. A separate and usually harmless complaint is eyelid twitching, a fine flicker of the lid that almost always settles on its own. Neither is dangerous, but both can be persistent, and both respond well to the right approach.

Lumps and cysts on the eyelid

Most lumps on the eyelid are entirely benign. A stye is a tender, red swelling caused by a blocked and infected gland, while a chalazion is the firmer, painless lump that can be left behind when a gland stays blocked. The soft yellow patches that appear near the inner corner of the eyelids, called xanthelasma, are deposits of cholesterol in the skin. The great majority of these need either simple treatment or none at all. The reason to take any new eyelid lump seriously is not that most are sinister, because they are not, but that the small number which are deserve to be recognised early.

When an eyelid lump is something more

The skin of the eyelid is thin and exposed to a lifetime of sunlight, which makes it one of the more common sites on the face for skin cancer. These tumours are usually slow growing and highly treatable when they are found early, particularly the most common type, basal cell carcinoma. The features that should prompt assessment are a lump that grows steadily over weeks and months, one that bleeds or crusts and will not heal, any distortion of the lid margin, or the loss of lashes in one small area. As an oculoplastic surgeon, a significant part of my work is the removal and reconstruction of eyelid tumours, and the single most important message is a reassuring one: early assessment leads to simpler treatment and better results.

Signs worth acting on sooner

Most eyelid problems can be assessed at a routine appointment, but a few features deserve prompter attention.

If none of these apply, most eyelid conditions are not dangerous and are very treatable once the cause has been identified. If you would like to discuss an eyelid problem in person, you can find details of my private clinic in Newcastle through the clinic page.