Mok Hao Ting, Yong Loo Lin School of Medicine, National University of Singapore
An eyelid is a thin fold of skin that covers and protects the eye from foreign particles and debris. Eye care professionals often come across a multitude of eyelid disorders, such as chalazion, hordeolum, eyelid growths, epiblepharon, entropion, ectropion and ptosis. Dr Stephanie Young, Consultant at the Ophthalmology Department in National University Hospital (NUH), was an invited guest speaker at the Singapore Primary Eye Care Symposium (SPECS) 2019 held at One Farrer Hotel on 23-24 July 2019. She gave a lecture titled ‘Diagnosis and Management of Eyelid Disorders’.
Dr Young gave a brief overview of the anatomy of the eyelid. The eyelid is made up of several layers, namely the skin, subcutaneous tissue, orbicularis oculi, orbital septum and tarsal plates, and palpebral conjunctiva. She covered various conditions that affect the eyelids in her talk.
Chalazion, a non-infectious collection of lipid material from obstruction of Meibomian gland, can occur in both the upper and lower lids. With similar clinical presentations to that of an eye stye, chalazion is often mistaken as a stye. However, the onset of chalazion is painless and it is a chronic condition. Common treatments include the application of warm compress, eyedrops or topical antibiotic ointment. Chalazia do not pose any long-lasting harm to the health of patients and usually disappear within a few months after starting treatment. If the chalazion does not respond to warm compress, lid scrub and topical medication, eye care professionals may advise patients to undergo surgery to drain it.
Hordeolum, commonly known as a stye, is an acute focal infection of the sebaceous glands of Zeis, usually caused by Staphylococcus aureus bacteria. Hordeolum is characterised by an acute onset of symptoms and patients often suffer from pain, red and swollen eyelids. It is recommended for patients to use warm water compress or antibiotic eye drops to promote faster healing. Hordeolums usually disappear within a week.
Eyelid growths are common, and can be categorised into two categories – benign and malignant lesions. Benign lesions include squamous cell papilloma and seborrheic keratosis. Malignant lesions are often associated with distortion of normal eyelid architecture, loss of eyelashes and ulceration. Cases of benign lesions can be treated with cryotherapy, imiquimod 5% cream or other topical agents.
Epiblepharon, also known as having an ‘extra eyelid’, is prevalent amongst east Asian children and mostly affects the lower lids. In such a condition, the eyelid pretarsal muscle and skin ride above the eyelid margin to form a horizontal fold of tissue, causing the cilia to assume a vertical position. Children with epiblepharon often rub their eyes and experience irritation, discomfort and itch in the eyes. For such cases, non-incisional suture correction can be carried out. Otherwise, incisional procedures such as the modified Hotz procedure, cilial rotational suture and Asian blepharoplasty can also be performed by eye care professionals.
Entropion and ectropion are age-related eyelid disorders. Entropion presents as the turning inward of the lid, toward the globe, and commonly affects the lower lid. As the eyelashes brush against the globe, patients may complain of blurred vision, discomfort, crusting of the eyes and a gritty sensation of the eye. Eye care professionals may suggest the patient to undergo a non-incisional everting suture procedure to relieve them of the symptoms. Next, ectropion is an outward turning of the eyelid margin away from normal contact with the eye. Paralytic ectropion involves the seventh nerve palsy, resulting in a decreased orbicularis muscle tone supporting the lower eyelid. Elderly patients with ectropion often experience symptoms of pain, excessive tearing and hardening of the eyelid conjunctiva. Management of ectropion is a multidisciplinary approach, involving lubricants, taping of eyelids and tarsorrhaphy.
Lastly, ptosis is the drooping or falling of the upper eyelid. This is usually due to weakness or paralysis of the levator muscle, or damage to the innervation of the muscle. The cause of ptosis is multifaceted, ranging from aponeurotic, myogenic, neurogenic, mechanical to traumatic causes. Risk factors related to ptosis include diabetes, stroke, Horner syndrome and Bell’s palsy. Proper clinical assessments, such as cyclorefraction (for children), palpebral aperture, levator function and Bell’s phenomenon should be carried out by trained eye professionals to make an accurate diagnosis. Surgery is usually the best treatment for ptosis, in which the levator muscles will be tightened to lift the eyelids, allowing patients to have improved vision and appearance.
Eyelid disorders are many and varied, requiring specific management and treatment plans. Dr Young urged eye care professionals to carry out proper clinical assessments in order to make a proper diagnosis and provide the best for patients.