General Medical Information

Eyelid Abnormalities and Blepharitis

Jean Edwards Holt

Many common disorders affect the eyelids. A sty (hordeolum) is an acute infection of one of the glands in the eyelid, similar to a boil or furuncle of other areas of the skin. The patient typically has a red eyelid with moderate tenderness and swelling in the involved area. There may be associated redness of the conjunctiva. These lesions usually are self-limiting and drain spontaneously, or the patient can be treated with warm compresses and topical antibiotics. A chronic lipogranulomatous structure known as a chalazion can be caused by an abnormality in the meibomian glands of the eyelid. If the patient requests treatment, this lesion usually necessitates surgical incision and drainage. Diffuse inflammation or infection of the eyelids is known as blepharitis. It characteristically has two forms. The first is a chronic staphylococcal infection of the glands surrounding the eyelashes. Abnormal oil secretions from these glands irritate the eye and cause redness and sometimes small whitish infiltrates in the cornea near the limbus. The other form is blepharitis associated with typical seborrhea of the scalp, eyelashes, and eyebrows. These conditions tend to cause swelling of the eyelids, a moderate amount of erythema of the lid margins, and mild to moderate conjunctival injection. The patient describes having irritated eyes with scaling or crusting of the eyelashes. Treatment is long term and is directed at eradicating the contaminated flora, controlling the scalp seborrhea, and cleaning the lids. Anatomic abnormalities of the eyelids, such as entropion with irritation due to misdirected eyelashes or ectropion, which causes poor tear function and corneal exposure, can be eliminated as the cause of redness by simple observation.