Eyelid problems
An eyelid is a moving curtain about as thick as paper, and a surprising amount is packed into it: a cartilage plate, two muscles, the roots of the lashes and…
On this page
- A lump on the eyelid: stye or chalazion
- Red lid margins that itch and stick
- A swollen lid: from an insect bite to a dangerous infection
- When the lid has dropped
- A lid turning in or hanging away
- Yellow plaques and other growths
- Looking after your lids, and what not to do
- When a doctor is needed urgently
- Online consultation
Medicines commonly prescribed for Eyelid problems
For informational purposes only. Always consult a doctor before taking any medication.
Dosage form: EYEDROP, 2 mg sodium carboxymethylcelluloseActive substance: artificial tears and other indifferent preparationsManufacturer: Abbvie Spain, S.L.U.Prescription requiredDosage form: EYEDROP, 3.2 mg/mlActive substance: artificial tears and other indifferent preparationsManufacturer: Bausch & Lomb S.A.Prescription not requiredDosage form: EYE DROP, 50 mg/mlActive substance: povidone-iodineManufacturer: Alfa Intes Industria Terapeutica Splendore S.R.L.Prescription required
An eyelid is a moving curtain about as thick as paper, and a surprising amount is packed into it: a cartilage plate, two muscles, the roots of the lashes and several dozen oil glands that supply the greasy layer of the tear film. That is why the complaints are so varied — a lump appears, the margins itch and stick together in the morning, the lid swells, the lid droops. The overwhelming majority of these stories come to nothing, and there is really only one thing to understand: the point at which the harmless stops being harmless. On the eyelids that line is a sharp one, because two conditions measured in hours live right next door to an ordinary stye. Twitching eyelids are not covered here: that is a separate subject and almost always benign.
A lump on the eyelid: stye or chalazion
The two commonest lumps look alike but behave differently, and telling them apart is worth doing, because what you do about them differs too.
A stye is an acute infection of a gland at the root of an eyelash. It sits right on the lid margin, it hurts, the skin over it is red, and within a day or two a yellow point appears. The whole thing develops over a few days and usually ends the same way on its own: the point discharges and the pain goes.
A chalazion is not an infection but a blockage. An oil gland has stopped emptying, the contents have stayed inside, and a firm painless bead has formed around them. It sits not on the margin but in the body of the lid, rolls under the finger, and the skin over it is a normal colour. It appears slowly, lasts weeks or months, and by no means always disappears by itself: if it will not settle or gets in the way of vision, it is removed by a small procedure in the eye clinic.
What helps both: a warm moist compress on closed lids several times a day, and gentle massage of the lid towards the margin, which softens the thickened oil in the gland and lets it find a way out. What must not be done with either is squeezing. The eyelids drain into the orbit through veins that have no valves, so contents squeezed outwards will just as happily travel inwards. That is how a harmless stye becomes a serious infection behind the eye. For the same reason, do not lance a lump with a needle and do not pull out the lash.
Red lid margins that itch and stick
If the lashes are glued together in the morning, if there are flakes and crusts along the lid margin, and the eyes are pinkish, slightly burning and gritty, that is blepharitis. It is not contagious, it does not damage sight, and it is almost never about dirt: it is about those same oil glands producing secretions that are too thick, so the tear film becomes unstable and the lid margin gets irritated. People with rosacea and with seborrhoeic dermatitis get it particularly often.
The main thing to know is this: blepharitis is not cured, it is managed. It is a long-term condition with flares and quiet spells, and it rests on daily lid hygiene carried out for months and years, not as a ten-day course. The routine is simple and much the same for everyone:
- a warm moist compress on the lids for a few minutes, to soften the oil inside the glands;
- gentle massage of the lids towards the margin;
- cleaning the margin itself and the base of the lashes, with a cotton bud or a wipe and a product made for lid hygiene, rather than soap, which dries the skin;
- preservative-free lubricating drops if there is dryness and soreness.
All of it continues once things have improved, otherwise everything comes back within a few weeks. And one more point: antibiotic ointments used "just in case" do not help here. Blepharitis is mostly not a bacterial problem, and an ointment applied for months without an indication only irritates the lid margin further. Antibiotics for eyelid conditions are prescribed by a doctor, for a specific reason.
A swollen lid: from an insect bite to a dangerous infection
Eyelids swell easily: the skin here is the thinnest on the body and the tissue beneath it is loose, so fluid collects readily. Most often the cause is harmless — an insect bite, an allergy to cosmetics or to drops, a sleepless night, hives, conjunctivitis. Allergic swelling is recognised by the itch, by the fact that it is frequently on both sides, and by skin that is pale and glassy rather than red.
But the swollen lid is also where a genuine emergency hides. Infection of the soft tissues around the eye comes in two forms, and one thing separates them: whether it has passed the septum into the orbit or not. A doctor or an ambulance is needed immediately if redness and swelling are joined by even one of the following:
- pain on moving the eye, with the movements themselves restricted;
- double vision or worsening sight;
- the eye looking pushed forward;
- fever, shivering, feeling generally very unwell;
- swelling that has taken in the whole lid and is growing quickly, with hot purplish skin.
That is a description of orbital cellulitis, a collection of pus behind the eye. It is treated only in hospital and intravenously, and delay risks loss of vision and spread of the infection inside the skull. Be especially wary with a child: this develops fastest in children, often after a cold, and "the eye is just a bit puffy" is not the situation in which you wait until morning.
When the lid has dropped
A drooping lid — ptosis — is not a disease in itself but a sign, and everything depends on how fast it came on and what came with it.
Lids drop with age in everybody: the tendon of the muscle that lifts the lid stretches and the skin hangs over as a hood. This takes years, it is symmetrical or nearly so, nothing else goes with it and it carries no danger; it is corrected on request, or on medical grounds if the lid covers the pupil and narrows the field of vision.
It is an entirely different conversation when a lid drops quickly. Call an ambulance if ptosis has come on suddenly together with double vision and pupils of different sizes — particularly if the wider pupil is on the side of the drooping lid and there is a headache. That is the picture of a third nerve palsy, and one of its causes is an aneurysm of an artery at the base of the brain, which can rupture. This is investigated within the hour, not by appointment.
Two further pictures must not be missed:
- ptosis with a small pupil on the same side, a slightly sunken eye and loss of sweating over half the face — Horner's syndrome. If it appeared suddenly and with neck or head pain, a torn carotid artery is excluded urgently;
- a lid that droops more by evening than in the morning, especially alongside double vision, a nasal voice, choking on food or weak arms — that is how myasthenia begins. Difficulty swallowing or breathing with it needs emergency care.
Babies deserve a separate note: if a child's lid covers the pupil, that eye stops learning to see, and it should be shown to an eye specialist rather than left until school age.
A lid turning in or hanging away
In older people the tissues of the lid lose their elasticity and the margin stops sitting against the eye as it should. One of two things follows.
Turning in: the margin rolls inwards and the lashes rub the cornea. It feels like a permanent speck of grit, with redness, watering and dislike of light. This is not a cosmetic detail: the lashes scratch the cornea, and prolonged rubbing produces an ulcer on it, which is a threat to sight.
Turning out: the margin falls away from the eye, the tear duct opening no longer collects tears, so the eye streams constantly and the lower lid becomes red and thickened from the permanent wetness. The cornea, meanwhile, is covered less well and dries out.
Both are dealt with by a small operation that tightens the lid, and until then lubricating drops and an ointment at night help. A lid that turns out or in suddenly on one side only, especially with a lopsided face, calls for an urgent visit rather than a routine one: that is how a facial nerve palsy shows itself, and the eye then no longer closes, leaving the cornea unprotected.
Yellow plaques and other growths
Soft yellowish plaques at the inner corners of the lids, more often the upper ones, are xanthelasmas: cholesterol deposited in the skin. They do not affect sight, but they are a reason to have a lipid profile taken. Around half the people who have them turn out to have a disorder of fat metabolism, and in a young person they can be the first visible sign of inherited high cholesterol. They can be removed cosmetically, but that changes nothing about the metabolism.
And one thing that makes any long-standing lump on a lid worth a second look. Eyelid skin is a common site for basal cell cancer, which grows slowly and looks innocent for years. What should raise concern:
- a nodule or small ulcer that has not healed for weeks, bleeds a little and scabs over;
- a patch where the lashes have fallen out and are not growing back;
- a notch or distortion in the lid margin, a persistent thickening;
- a "chalazion" that keeps coming back in exactly the same place.
None of this means disaster, but all of it means an eye examination and sometimes a small biopsy: on the eyelids such tumours are cured completely when they are dealt with early.
Looking after your lids, and what not to do
Almost everything that helps eyelids costs very little and is done at home.
- Warm compresses and lid margin hygiene are the foundation for blepharitis, chalazion and dry eye — that is, for most long-running complaints.
- Take make-up off every evening; eyeliner drawn along the inner edge of the lid blocks those very glands. Replace mascara and liner regularly and never share them.
- During a flare, take contact lenses out and leave them out while there is discharge, pain or redness.
- Do not rub your eyes with your hands — that is the main way to introduce infection and carry it to the other eye.
- A cool compress soothes allergic swelling; a warm one only makes that kind of itching worse.
What should not be done: squeezing a stye, lancing any lump, and rinsing eyes with tea or herbal infusions. And a separate word on medicines. Antibiotic ointments and drops are not something to prescribe yourself: they do not speed up a stye and do nothing for an allergy, while they irritate the lid margin and teach bacteria not to fear the drug. Steroid drops and ointments even less so — without an examination they are dangerous, because in herpes of the eye they accelerate a corneal ulcer, and used long term they raise the pressure inside the eye.
When a doctor is needed urgently
Immediately — if it hurts to move the eye, if the eye is pushed forward, if double vision has appeared or sight has dropped; if a lid has drooped suddenly, especially with double vision and unequal pupils; if a wound to the lid involves its margin.
The same day — if a child's lid redness and swelling are increasing, all the more so with a fever; if severe eye pain and dislike of light have appeared.
Routinely — when a lump has lasted more than a few weeks, when blepharitis will not respond to home care, when the lid rubs the eye or the eye waters, when there are yellow plaques, and when something on the lid has changed and is not going back to how it was.
Online consultation
Remote care works better for eyelids than you might expect, because almost everything can be seen. From a photograph and the answers to a few questions the doctor can tell a stye from a chalazion, recognise blepharitis and explain how it is managed over years, judge whether the swelling in front of them is allergic or inflammatory, and work out whether an eye specialist is needed and how quickly. They can also advise which lid hygiene products to buy and how to use them, what to do about make-up and lenses, and suggest a cholesterol check if they see xanthelasmas.
The limits of the format are firm, and with eyes especially so. Through a screen nobody can examine the eye with a slit lamp, turn the lid inside out, stain the cornea or measure the pressure inside the eye — which means damage to the cornea cannot be ruled out. And most important of all: pain on moving the eye, an eye pushed forward, a suddenly drooping lid with double vision, and any sharp fall in vision all need emergency care rather than a written consultation.
This material is for information only and does not replace medical advice.
Consult with a doctor about Eyelid problems
Discuss your symptoms and possible next steps with a doctor online.
Online doctors for Eyelid problems
Discuss your symptoms and possible next steps for Eyelid problems with a doctor online.
