Eyelid problems

Also called Stye, Blepharitis, Ectropion, Entropion, Chalazion

Lumps, crusting and lids turning in or out. Mostly minor, and lid hygiene done properly is the treatment people are told about least.

What it is

A group of common conditions of the eyelids.

**Blepharitis** is chronic inflammation of the lid margins, causing crusting, itching, grittiness and recurrent styes. It is the underlying cause of a great deal of eye discomfort and it is chronic: lid hygiene controls it and does not cure it, and stopping means it returns. It is associated with rosacea and seborrhoeic dermatitis.

**A stye** is an infection of an eyelash follicle, painful and at the lid edge. **A chalazion** is a blocked oil gland forming a firm painless lump within the lid, which often takes months to resolve.

**Ectropion** is the lower lid turning outwards, common in older people, causing watering, exposure and soreness. **Entropion** is the lid turning inwards so the lashes rub the eye, which is more urgent because it damages the cornea.

Both ectropion and entropion are surgically correctable, and older people are frequently left with chronically sore watering eyes that could be fixed in a day case procedure.

The lump that must not be missed is a **basal cell carcinoma** of the eyelid, which is common: a pearly, ulcerated or persistently non-healing lump, or a distortion of the lid margin with lash loss, needs urgent assessment. See non-melanoma skin cancer.

Signs you might notice

Blepharitis: crusty, red lid margins, grittiness, burning, worse in the mornings, recurrent styes and dry eye.

Stye: a painful red lump at the lid edge, coming to a head over days.

Chalazion: a firm painless lump within the lid, present for weeks or months.

Ectropion: a lower lid turning outwards, watering, soreness and exposure.

Entropion: lids turning inwards, lashes rubbing, foreign body sensation, redness and watering.

Urgent: spreading redness and swelling of the eyelid and around the eye with fever, pain on eye movement, bulging of the eye, or double vision. That may be orbital cellulitis and is an emergency.

Also urgent: any persistent, ulcerated, pearly or bleeding lid lump, or loss of lashes at a lump, which needs assessment for skin cancer.

How it can affect day-to-day life

Lid hygiene is the treatment for blepharitis and is done badly or not at all by most people who are told to do it. The method matters: a warm compress held on for several minutes to soften the oils, then gentle massage of the lid margins, then cleaning the lash line with a cotton bud and diluted baby shampoo or a proprietary lid wipe. Done daily at first, then several times a week for life.

People stop when symptoms settle and conclude it failed when they return. Framing it as maintenance, like brushing teeth, changes adherence.

For styes, warm compresses several times a day help; squeezing does not, and antibiotic drops rarely help.

A chalazion often takes months and warm compresses and massage resolve most; minor surgery is available for persistent ones.

For older people in care, chronically watering, crusted eyes are common and are frequently accepted rather than treated, and they cause real discomfort and social embarrassment.

Ectropion and entropion surgery is quick, effective and under-referred.

Supporting someone well

Do lid hygiene properly: warm compress for several minutes, gentle massage, then clean the lash line. Daily at first, then ongoing.

Keep going after symptoms settle; it is maintenance, not a course.

Use warm compresses for styes and chalazia, several times a day. Do not squeeze.

Do not expect antibiotic drops to help most lid problems.

Treat associated rosacea and seborrhoeic dermatitis.

Ask for referral for ectropion or entropion surgery rather than living with a watering sore eye.

Get any persistent, ulcerated or bleeding lid lump, or lash loss, assessed urgently.

Treat spreading redness around the eye with fever as an emergency.

Include eye care in the daily care plan for anybody who cannot manage it themselves.

Where to get help

A pharmacist or optometrist for lid hygiene advice and products.

A GP practice for persistent problems and for referral for lid surgery.

A and E or eye casualty for spreading redness with fever, pain on eye movement, or double vision.

RNIB and Fight for Sight for eye health information.