THE OPTOMETRIC TECHNICIAN – APRIL 2017

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Lubricant eye drops, such as Soothe XP from Bausch + Lomb, are used to treat symptoms of eyelid disorders, including blepharitis, ectropion and entropion.
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Over-the-counter lid hygiene products, such as those
from OCuSOFT, help control chronic blepharitis.

8 common eyelid disorders and how to treat them.

As optometric technicians we need to understand the various diseases and treatments of the eyelid so we can gather the necessary information for the doctor to properly diagnose the patient’s condition.

THE CONDITION: STY
What causes it: Also known as a hordeolum, a sty is an infection of the sebaceous gland of Zeis. It is usually caused by staphylococcus aureus bacteria and is characterized by an acute onset of swelling. It looks like a painful lump, boil or pimple near the edge of the eyelid. While they usually form on the outer lid, they can also form on the inner lid (common in patients with staph blepharitis).

How to treat it: Warm compresses to the eyelid for 10 minutes, three to four times a day may promote faster healing. A sty is normally harmless, does not cause long-lasting damage and usually disappears within a week without treatment.

THE CONDITION: BLEPHARITIS
What causes it: Blepharitis is an inflammation/irritation of the eyelid margins, typically around the eyelashes, often with scales and crust. It can be caused by a bacterial infection or an over-production of oil by the meibomian glands.

How to treat it: Usually a chronic condition, blepharitis can begin in early childhood and last throughout life. Symptoms include itching, a feeling that something is in the eye, inflammation, scales, mattering or hard crust just above the eyelashes. Limiting or stopping the use of eye makeup is often recommended, as its use will make lid hygiene more difficult. Warm compresses can be applied to loosen the crusts, followed by gentle scrubbing of the eyes with a mixture of water and baby shampoo or an over-the-counter lid-cleansing product (see At-a-Glance on page 28). In cases involving bacterial infection, an antibiotic may also be prescribed. If the glands in the eyelids are blocked, the eyelids may need to be massaged to clean out oil accumulated in the eyelid glands. Artificial tear solutions or lubricating ointments may be prescribed in some cases, while others may require more complex treatment plans.

THE CONDITION: CHALAZION
What causes it: A chalazion can develop when the oil produced by the meibomian glands becomes thickened and is unable to flow out of the gland. The oil builds up inside the gland and forms a lump in the eyelid. Initially, a chalazion may appear as a red, tender, swollen area of the eyelid. Eventually, the gland may break open and release the oil into the surrounding tissue causing an inflammation of the eyelid. It often starts out very small and barely visible, but it could grow to the size of a pea. They may be confused with sties, which are also areas of swelling in the eyelid.

How to treat it: Apply warm compresses to the eyelid for 10 to 15 minutes, four to six times a day for up to seven to 10 days. The warm compresses may help soften the hardened oil that is blocking the ducts and allow drainage and healing. Also, gently massage the external eyelids several minutes each day to help promote drainage. Once the chalazion drains, keep the area clean, and keep hands away from eyes. A chalazion will heal within a few months if treated. They will usually resorb within two years.

THE CONDITION: BLEPHAROSPASM
What causes it: Commonly known as eyelid twitching, blepharospasm is an involuntary spasm of the eyelid muscle. The most common causes are fatigue, stress or caffeine.

How to treat it: Eyelid twitching is not considered harmful, so there is no treatment available. However, the doctor may advise the patient to get more sleep and consume less caffeine.

THE CONDITION: EYELID EDEMA
What causes it: This is most often caused by allergic reactions to eye makeup, eye drops, drugs or allergens (dust, pollen, etc.). If the patient is experiencing eyelid swelling on a regular basis it could be due to an allergic reaction to fragrances, make-up or laundry detergent. If there are no known allergies, there could be a more serious problem.

How to treat it: A cold, damp cloth on swollen eyelid(s) twice a day or splashing cool water on the face helps to reduce facial swelling. The doctor may prescribe a prescription-strength antihistamine, eye drops or an ointment to treat the swelling. The doctor will also be able to determine whether there is an infection or not.

THE CONDITION: ENTROPION
What causes it: This abnormal turning in of the eyelid, which causes the lashes to rub on the ocular surface, is usually due to aging. Other causes may include a congenital defect, a spastic eyelid muscle or a scar on the inside of the lid from surgery, injury or disease. It is an asymptomatic condition that can rarely lead to trichiasis, which requires surgery. It mostly affects the lower lid.

How to treat it: Ocular lubrication and tear preparations are helpful for protecting the ocular surface and also may break the cycle in patients with spastic entropion due to dry eye syndrome. Small amounts (approximately 5U) of botulinum toxin (Botox)””are quite effective for the treatment of spastic entropion by weakening the pretarsal orbicularis oculi muscle.

THE CONDITION: ECTROPION
What causes it: This condition is where one or both eyelid margins turn outward. Ectropion typically affects the lower lid, which exposes the inner conjunctival side of the eyelid, and like entropion, it is usually due to aging (though it may be the result of allergies). Its main symptoms are pain, excessive tearing and hardening of the eyelid conjunctiva.

How to treat it: Artificial tears may ease dryness and keep the cornea moist. Using artificial tears or lubricating ointments may prevent injury to the cornea. Surgery to tighten the muscles that hold the eyelids in place is very often effective.

THE CONDITION: PTOSIS
What it is: Drooping eyelids may occur due to trauma, age or various medical disorders. This condition can affect one or both eyes; it may come and go or might be permanent. Children who have ptosis may also develop amblyopia, commonly known as lazy eye. This disorder can also delay or limit their vision. Depending on the severity of the condition, drooping eyelids can block or greatly reduce vision depending on how much it obstructs the pupil.

How to treat it: Eyelid drooping isn’t usually harmful to a patient’s health, but when it blocks the vision the doctor may recommend surgery. During surgery, the levator muscle is tightened. For children who have ptosis, doctors may recommend surgery to prevent the onset of amblyopia or lazy eye.

Roberta Beers, CPOT, is an optometric assistant in Erie, PA.

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