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Eyelid problems & Blepharitis

Find out more about eyelid problems and Blepharitis

Blepharitis

 Blepharitis is an inflammatory condition affecting the eyelid edges, causing symptoms of soreness, dryness, foreign body sensation and irritation and occasionally intermittent blurred vision or fluctuation in the quality of the vision. The eyelid margins are typically red, thickened and irregular, and may have crusting or oily discharge. However in a substantial proportion of patients the eyes may appear normal to the naked eye, but your ophthalmic surgeon or optometrist will be able to diagnose this condition using a the slit lamp biomicroscope.

Blepharitis is caused by the irritant effects of eyelid secretions, debris and waste products of bacteria normally present on the lid margin and by an excessive response of the patient’s immune system. Some people are prone to blepharitis and will experience waxing and waning of symptoms over many years. People with Rosacea (a skin complaint affecting the cheeks and nose) are particularly prone to troublesome blepharitis. Blepharitis may begin at any age.

Treatment

Treatments may include lid hygiene, ocular lubricants, antibiotic and steroid eye drops or ointments, and oral antibiotics.

Lid Hygiene Solution

A daily clean of the lids and lashes with a cotton bud and a special solution is recommended. Alternatively one can purchase pre-soaked wipes with solution in order to clean the lids and lashes. Lid hygiene should be continued typically once a day to help prevent further problems. Specific complications may require additional treatment options.

Chalazion

A chalazion forms when one of the meibomian or tarsal glands of the eyelid becomes blocked. The oily contents it normally releases into the tear film instead build up within the eyelid, resulting in a painless or sometimes sore and inflamed eyelid lump.

Treatment

Hot bathing and lid hygiene (see Blepharitis) may prevent a chalazion forming if started in the early stages of the condition, but once it becomes chronic, in many cases incision and curettage, or eyelid steroid injections are the only means of removing a chalazion. This procedure can be carried out in the out-patient clinic, under local anaesthetic.

Incision and Curettage

Anaesthetic eye drops are given and then an injection of anaesthetic into the affected eyelid. The eyelid is then gently flipped over to expose the inner surface. This is then incised and the contents of the cyst curetted (scraped) out .

Antibiotic ointment is then applied with a pad. This is left on for 4 hours to reduce bruising, with antibiotic ointment given to apply 4 times daily for a further week.

Bruising of the eyelid is common and may take a week or two to go. Infection is rare.

Often the lid is thickened and inflamed around the cyst, this thickening may take a few weeks to settle even after incision and curettage. Chalazia may recur, or may form in other eyelids or parts of the same eyelid.

Oculoplastics

Includes a wide wide variety of surgical procedures which deal with the eye socket or orbit of the eye, eyelids, tear ducts. Reconstruction of the eye and associated structures.

Our Oculoplastics surgeons perform procedures such a the repair of droopy eyelids (blepharoplasty) tear duct repairs and obstructions, orbital fracture and removal of tumours in and around the eyes, eyelid reconstruction

Ptosis

Ptosis is most common in older people, although you can be born with it.

In adults, ptosis usually develops when the muscle that lifts the upper lid stops working properly because its tendon has stretched. In babies, ptosis is caused by muscles in the eyelid not developing properly. If your child is born with a drooping eyelid, or develops one before he or she is a year old, the condition is called congenital ptosis. It is important that your child’s vision is monitored closely as he/ she may be at risk of developing a lazy eye.

Ptosis varies in severity. For example, mild ptosis may cause your eyelid to droop a small amount, which can affect your appearance but not your sight. The skin creases in your upper eyelids may also look uneven – this may be particularly noticeable in photographs. If it is more severe, it can restrict the upper part of your field of vision.

Symptoms of ptosis

The first and most obvious symptom of ptosis is a drooping eyelid. This can make you look tired and sleepy.

You may find that you have to start tilting your head back to see properly. The way the eyelid droops may also affect the upper area of your vision. If ptosis is severe, you may need to use your finger to lift the lid to see properly.

If your child has ptosis, you may notice similar symptoms, especially tilting of the head. Your child may raise his or her eyebrow to lift the lid.

Watering eyes

It is caused when tears don’t drain away properly (epiphora) or too many tears are produced (hypersecretion).

Epiphora and hypersecretion of tears can occur as a result of conditions such as conjunctivitis (eye inflammation), an eye injury, or something irritating your eye.

Otherwise it can be caused by blockage or narrowing of the tear drainage system, or a combination of both. It is most common in young babies (0-12 months) when the tear duct is not fully open and people over the age of 60 when there is increasing dry eye and narrowing of tear drainage system. It can affect one or both eyes and can cause blurred vision, sore eyelid skin and sticky eyes.

How tears work

Tears are constantly produced to keep the eyes moist. They are produced in the small gland called the lacrimal gland and in the small cells found in the membrane that covers the eyeball (conjunctiva). When you blink, tears are spread over the front surface of your eyes (cornea and conjunctiva).

The tears drain away through tiny ducts known as puncta and then into channels known as canaliculi, which are found on the inside of your eyes. The tears drain into a tear “sac” before flowing down a tube and into your nose.

Treatment is not always necessary for watering eyes and mild cases may be improved with hot compresses and lid massaging, but it depends on how severe your watering eyes are and what is causing it. For example, if you have a blocked or narrowed tear duct, then surgery such as a DCR may be required to unblock it.

Dacrocystorhinostomy (“DCR”)

The usual cause of a watering eye is meibomian gland dysfunction, whereby there is a deficiency in the oily layer of the tears. This causes the tears to become watery in consistency, which in turn causes dry patches on the eye and extra tears are produced as a reflex, resulting in watery eyes. However in a significant proportion of patients there could also be narrowing or blockage of their tear drainage. This would result in too much build up of the tears causing overflow. The tears normally drain from the corner of the eye close to the nose, via tiny puncta into the very fine lacrimal drainage channels (canaliculi). The tears go into the lacrimal sac, then down the nasolacrimal duct which lies in a bony canal, then opens into your nose.

The status of the tear drainage system is assessed by the lacrimal surgeon performing syringing to see whether fluid flows through the system.

Surgery to overcome this blockage or narrowing is called “dacrocystorhinostomy” or DCR.

DCR consists of creating a direct connection between the tear sac into the nose, bypassing the blockage and allowing tears to drain normally again. Usually some soft silicone tubes are placed to stent the newly created passage, which are removed about two months after surgery.

There are two methods of doing this: your lacrimal surgeon will advise you as to which method is preferable:

Externally (from the outside, via a short skin incision)

Internally (from inside the nose: endonasal endoscopic)

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