Blepharospasm

Introduction

Eyelid problems are common but rarely serious.

A cyst (fluid-filled sac) can sometimes develop on the eyelid, or the eyelid can get inflamed or infected. Changes in the position of the eyelids, such as droopiness, often occur gradually with age. 

These problems are usually nothing to worry about. However, see your GP if your eyes are watery or uncomfortable due to an eyelid problem, or if you are worried. Seek urgent medical advice if you also have pain in or around your eye or loss of vision.

The information below should give you an idea of what might be wrong, although it shouldn't be used to self-diagnose your condition.

It covers possible causes for the following eyelid problems, plus specific advice about what to do:

Swollen eyelid or eyelid cyst

It's quite common for the upper or lower lid to become swollen due to the formation of a meibomian cyst (also called a chalazion).

Meibomian cysts vary in size, from just visible to the size of a grape. They usually take weeks to develop. They're not particularly painful, but will become red and painful if infected.

Usually, these cysts come and go by themselves. You can increase the chance of the cyst healing by holding a clean flannel warmed in hot water to the closed eye for five minutes. Repeat this three to four times a day for two weeks.

Speak to your GP if you have a large cyst that doesn't clear up after a couple of months. They can refer you to have it surgically drained. This is a simple procedure carried out under local anaesthetic (your eye area will be numbed). It takes just five minutes and doesn't leave a scar.

Also see your GP if the cyst becomes infected because you may need to take antibiotics to prevent a deep lid infection (cellulitis).

Meibomian cysts aren't the same as styes. Styes are minor infections of the base of an eyelash and nearly always clear up on their own. In rare cases, styes can cause a lid infection (the lid will be red, hot and painful) and antibiotics will be needed.

Meibomian cysts and styes aren't caused by poor personal hygiene. They are, however, related to blepharitis, which is inflammation of the edge of the lid that causes oily tears (see gritty, itchy or flaky eyelids below).

Other causes of lid swelling are rare. These include; an allergic reaction, shingles on the face and eye (usually with a rash), and other rare eye problems, which would cause other symptoms such as loss of vision.

Gritty, itchy or flaky eyelids

Gritty or burning eyes are usually caused by an inflamed lid edge (blepharitis) or dry eye. Symptoms are usually worse in the morning or at the end of the day.

People with blepharitis also have an increased risk of getting meibomian cysts, also called chalazia, in their lid (see above).

Gritty, itchy or flaky lids are irritating, but rarely serious. You can reduce the irritation by keeping the lid clean and using artificial tears. Read about treating blepharitis.

Contact dermatitis is another possible cause of itchy or flaky lids. This is a type of eczema triggered when the skin comes into contact with something you are irritated by or allergic to. For example, your eyelids may be sore and itchy because you're allergic to the eye shadow you've been using or because you've been touching your eyes with fingers painted with nail polish. The condition usually clears up after you stop using the substance your skin is reacting to.

Lumps on the eyelid

Just like anywhere else on the skin, lumps can occur on the eyelids. Many lumps are simple cysts (see above).

However, see your GP if the lump increases in size, changes colour, has an irregular shape or bleeds. It's possible that the lump could be skin cancer.

If the lump is skin cancer, it may need to be surgically removed. Most skin cancers are basal cell carcinomas and don't spread to other parts of the body, although they continue to grow on the lid.

Less commonly, the lump may be a squamous cell carcinoma, which rarely spreads to other parts of the body.

If the lump is dark in colour, it could be a melanoma, although this is relatively rare. A melanoma will need early treatment because it can spread to other parts of the body and can be dangerous.

Droopy upper eyelid

As you get older, it's quite common to have excess skin above the upper eyelid. This is called dermatochalasis and it can overhang and block your vision. If it affects your vision, surgery may be considered to remove the excess skin (blepharoplasty).

If the edge of your upper lid droops down, reducing eye opening, it's called ptosis. Ptosis is usually age-related  and develops slowly. Surgery may be needed if the edge of the lid droops so much your vision is affected.

In rare cases, ptosis isn't related to age and may be caused by other conditions. In this case, it's likely there would be other symptoms too.

See your GP immediately if ptosis comes on rapidly, over days or weeks, or if it's associated with other symptoms, such as headache or vision loss.

Lower eyelid that rolls outwards (ectropion) 

The lower eyelid can sometimes droop away from the eye and turn outwards. This is known as an ectropion.

Ectropion can affect just one or both  of the lower eyelids. It's usually related to ageing, but can also be associated with sun-damaged facial skin.

In cases of mild ectropion, treatment isn't needed. However, if it's uncomfortable or causes your eye to continually water, surgery may be considered.

Read more about treating ectropion.

Eyelids that roll inwards (entropion)

Entropion is where the eyelid rolls inwards. It usually affects the lower lids, but it can also affect the upper lids.

Entropion usually causes an uncomfortable watery eye because the lashes irritate the front of the eye (cornea). If this is mild, using eye drops may be enough to protect the eye and keep you comfortable.

Severe entropion can be painful and cause vision loss by damaging the cornea. A corneal ulcer can form and become infected. Surgery may be needed to correct entropion if it's posing a risk to the health of your eye. This is carried out under local anaesthetic and usually takes less than an hour.

If you have entropion, you should discuss your treatment options with your GP. Consult your GP immediately if your eye becomes painful, red and you lose vision.

Yellow plaques on the eyelids

Flat yellow patches (plaques) over the upper or lower eyelids are called xanthelasma. 

Although these plaques are harmless, they indicate you may have a high cholesterol level. See your GP to assess your risk factors for future blood vessel problems, such as heart attacks and strokes.

It's important to have treatment if you have high cholesterol, high blood sugar (diabetes) and high blood pressureStopping smoking will also help reduce your risk of developing future blood vessel problems.

Excessive blinking or uncontrollable closure of the eyelids

It's quite common and normal for the eyelid to flicker or twitch occasionally, particularly when you're tired.

It's more unusual to have repeated spasms of excessive blinking and involuntary closure of the eyes. This is known as blepharospasm. Each spasm can last for a few seconds to a few minutes.

The exact cause of blepharospasm is unknown. However, the blinking and closure may be triggered by bright light, stress or tiredness.

Severe blepharospasm can be very disabling and embarrassing. However, an effective treatment is available. It involves having small injections of botulinum toxin (Botox) into the facial skin to provide relief. See your GP to discuss this.

Find out more about blepharospasm by reading the US National Eye Institute's facts about blepharospasm.

Useful Links