Several different glands are located throughout each eyelid, and they produce tears to lubricate the eye and keep it moist. The simple act of blinking spreads a thin layer of tears across the surface of the eye and flushes out debris.
Eyelids are complex structures made up of muscle, skin, glands, ligaments, blood vessels and nerves. Their delicate composition means they can develop different disorders, affecting eye health and vision. Fortunately, most eyelid disorders can be easily treated.
Common eyelid disorders include:
- Ectropion - lower eyelid is turned outwards
- Entropion - lower eyelid is turned inwards
- Ptosis and dermatochalasis - droopy eyelids caused by excess skin or low lid position
- Eyelid tumours - these can be benign but can also be types of skin cancer
- Blocked tear duct - this leads to watery eyes
- Blepharitis - inflammation of the eyelids
Ectropion occurs when the lower eyelid turns outwards, which leaves the eye exposed and at risk of drying out. Ectropion is more common in older adults, as the eyelid muscles can lose strength as we age, which means the skin around the eye is not as taut. Other causes include long-term sun damage to the skin, and conditions affecting the facial nerves and muscles, such as Bell’s Palsy.
Symptoms include a sandy or gritty feeling in your eyes, redness, watery eyes, and sensitivity to light. Symptoms of ectropion can be relieved with eye drops and ointments, but only surgery will restore the lid to its correct position.
Treatment - ectropion surgery
Surgery to correct ectropion usually takes around 30-45 minutes and is performed as a day case, so you will not have to stay in hospital overnight. The procedure is normally done using local anaesthetic which means you will be awake but will not be able to feel pain.
Occasionally a skin graft is required to allow the eyelid to return to normal. If this is the case the surgeon will explain this when you are assessed in clinic. If a skin graft is required, the procedure will be more complex and take longer as a result.
In this condition, the lower eyelid turns inwards, which means eyelashes and skin rub against and irritate the delicate eye surface. Left untreated, severe entropion can damage the cornea, leading to infection and potential loss of vision. Surgery is often required to correct the condition and prevent further eye injury. Age-related weakness of the eyelid muscles is the most common cause of entropion, but it can also result from infection and inflammation.
Symptoms include eye redness, irritation, watery eyes, sensitivity to light and mucus discharge. You should seek immediate medical advice if you experience decreasing vision, eye pain and increasing redness of the eye, as this could be caused by infection and signal damage to the cornea.
Treatment - entropion surgery
The operation to correct entropion usually takes around 30-45 minutes and is performed as a day case, so you will not have to stay in hospital overnight. The procedure is normally done using local anaesthetic which means you will be awake but will not be able to feel pain.
Ptosis (droopy eyelid)
Ptosis, also known as a droopy eyelid, is when the upper lid hangs low over the eye. In severe cases ptosis can reduce or completely block vision. This condition can happen at any age. The most common cause is age-related weakness of the eyelid muscles responsible for lifting the eyelid. There are many other causes and the initial assessment will look to establish the cause. To do this, you may be sent for blood tests or medical imaging. Once a cause is identified, surgery is often recommended to restore vision and help the eyelid muscle function properly.
A droopy eyelid and impaired vision (in severe cases). Occasionally ptosis can signal a medical emergency. If you suddenly develop a droopy eyelid, with or without double vision or headaches, you should seek emergency medical attention with your GP or the local Emergency Department.
Ptosis treatment - surgery
If the cause of a droopy eyelid is aging, then a surgical procedure will normally be required to reposition the eyelid to its normal height. This involves tightening eyelid muscles, so they can function properly. The operation usually takes around 30-45 minutes and is performed as a day case, so you will not have to stay in hospital overnight. The procedure is normally done using local anaesthetic which means you will be awake but will not be able to feel pain.
Sometimes the upper lid has significant excess skin which hangs down and blocks vision. This is called dermatochalasis. It is usually caused by aging.
Excess skin can make the eyelids look “hooded” and excess skin can affect the field of vision. Often patients find they hold the skin up to improve their sight.
Treatment – Blepharoplasty
If there is excess upper eyelid skin then a surgical procedure will normally be required to remove the excess skin. This operation usually takes around 30-45 minutes and is performed as a day case, so you will not have to stay in hospital overnight. The procedure is normally done using local anaesthetic which means you will be awake but will not be able to feel pain.
Eyelid tumours and cysts
Lumps and bumps around the eyelids are common. These can vary significantly from simple cysts (blocked glands) to serious skin cancers. If you experience a new growth on the eyelids you should seek advice from your optometrist or General Practitioner as soon as possible. They may then refer you on for a specialist assessment.
Your ophthalmologist can examine any growth on your eyelid and surgically remove it for testing (surgical biopsy) if required.
Eyelid tumours are often caused by long-term sun exposure. Close-fitting, wraparound sunglasses and a broad-rimmed hat are recommended to protect the eyes from harmful UV radiation. The most common eyelid tumours are basal cell carcinoma, often called a rodent ulcer, and squamous cell carcinoma. Both are normally treated with surgical excision.
Treatment for cysts can be conservative with antibiotics and lid hygiene measures. Persistent cysts can be treated surgically as a minor procedure in the clinic.
Cancerous eyelid tumours are normally surgically removed. The extent of surgery will vary dependent on the size and location of the tumour. Reconstruction of the eyelid is important to restore function. Specific details of your surgery will be explained by your ophthalmologist.
Other eyelid conditions
Blepharitis is a very common inflammation of the eyelids that causes reddening of the eyes and eyelids, irritation, watering, dry eyes and an awareness of the eyes. This chronic condition occurs when small glands near the eyelashes become blocked. The bacteria that naturally live on our skin cause ongoing inflammation.
While uncomfortable and troublesome, blepharitis does not usually damage your eyesight. Warm compresses of the eye area can help alleviate symptoms, and sometimes antibiotics are prescribed for their anti-inflammatory properties.
As blepharitis is an ongoing condition, symptoms can come and go, and the condition is often managed by General Practitioners and optometrists.
Blocked tear duct
A blocked tear duct occurs when the eye’s internal drainage system narrows, resulting in a build-up of tears in the lacrimal sac, located in the side of the nose. The eye becomes watery and irritated, and the risk of infection is increased. In adults a blocked tear duct is commonly caused by injury, infection or inflammation.
What happens during eyelid surgery?
Most eyelid surgery is performed with the patient awake. Local anaesthetic eye drops will be placed into your eyes and then your face cleaned for surgery. Local anaesthetic will be injected under the skin to completely numb the area to be operated on – which means you will feel no pain during surgery.
As it is an outpatient procedure you can return home the same day. You will need someone to drive you home after surgery.
Depending on the type of eyelid surgery, you may require stitches. These are removed one or two weeks after surgery. You will experience swelling and bruising after eyelid surgery for up to two weeks, which can be relieved with ice packs and pain medication.
Why choose St George’s Eye Care for my eyelid surgery?
Dr Paul Baddeley specialises in surgical treatment of eyelid disorders. He completed oculoplastic (eyelid surgery) fellowships at the University Hospital of Wales in Cardiff and the John Radcliffe Hospital in Oxford. Since becoming a consultant in 2011 Dr Baddeley has continued to work and specialise in eyelid disorders and their treatment. He also maintains membership of the British Oculoplastic Surgery Society.
Eyelid surgery is performed in the clinic in our dedicated treatment room, or if required, in our state-of-the-art operating theatres at St George’s Hospital, using the latest surgical techniques.
We appreciate that any surgery involving your eyes is a big step and requires careful consideration. We encourage you to take an active role in your treatment plan, and our ophthalmologists will help you make an informed decision.
You should seek medical advice from your optometrist or GP if you are concerned about any eyelid symptoms. They can refer you to an ophthalmologist such as St George’s Eye Care for further tests and treatment if required.
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