Introduction:
Eyelids are an important part of the eye. They are essential for preventing injury to the eye from foreign bodies, dust, and sand. Blinking the eyes helps retain moisture, prevents dryness, and provides a healthy and clean environment. Any disorder in the eyelid may cause difficulty in closing the eye, pain, and impaired vision. Eyelid deformity can be caused by infection, inflammation, or growth or congenital. These may lead to drooping, paralysis, loss of vision, and twitching.
What Are Different Types of Deformities of Upper Eyelids?
Different causes of eye deformity due to
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Malformation due to infection or inflammation.
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Malformation involving lesions.
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Mechanical disorders such as folds, eye margins, and position are malformations.
What Is Malformation Caused Due to Inflammation?
1. Blepharitis:
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Inflammation of the eyelid caused due to obstruction of the oil glands or accumulation of dirt.
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It is often associated with other skin conditions. It usually does not cause any vision loss and is not contagious.
It is associated with the following signs and symptoms
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Watery eyes.
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Redness.
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Swelling of the eyelids.
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Itchiness.
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Repetitive blinking.
2. Stye:
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It is a small red bump formed on the corner of the eye.
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It is a bacterial infection and usually resolves without any treatment.
3. Chalazion:
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Chalazion is a small cyst or bump caused due to inflammation or obstruction of the oil gland.
4. Meibomianitis:
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It is caused due to clogging of the oil gland at the base of eyelashes resulting in the thickening of the eyelashes.
5. Lacrimal Duct Obstruction:
- The lacrimal duct consists of a tiny hole near the inner corner of the eyes in both lids called the punctum.
- The punctum drains tears through channels called canaliculi which connect to the lacrimal sac and drains into the nose through the nasolacrimal duct.
- Any obstruction in any of these channels can cause eye infections, pain in the corner of the eye, and swelling.
What Are Treatment Options for Inflammation of the Eyelids?
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Treatment for the inflammation of the eyelids is usually simple, as the symptoms are reversible and heal without any treatment.
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Still, sometimes they may require treatment to prevent the discomfort and pain.
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Apply warm compresses on eyelids.
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Use of antibiotic cream.
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Cleaning eyes with mild baby shampoo.
What Is the Malformation Caused Due to Lesions?
1. Molluscum Contagiosum:
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This is characterized by the formation of wax nodules near the hair follicles. It is caused due to compromised immunity.
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It is a viral infection. It usually clears itself once the infection subsides.
2. Nevus:
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These are like birthmarks seen on the eyelids.
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They are usually flat and sometimes elevated.
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They are often irregular and should be evaluated by the doctor whenever there is a change in shape or size for melanoma.
What Are the Mechanical Malformations of the Eyelid?
A. Malformation Caused Due to Eyelid Folds:
1. Cryptophthalmos:
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It is usually called a hidden eye.
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In this condition, a sheath of skin extends from the forehead and covers the eyes.
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The upper and lower eyelids are fused. It is mainly caused due to incomplete development of palpebral fissures. It is either unilateral or bilateral.
Treatment:
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Reconstruction is usually complicated.
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It involves the use of skin grafts either from the mouth or nose to reconstruct the eyelids.
2. Microblepharon:
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It is a congenital condition caused by the decreased vertical height of the upper eyelid.
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It results in difficulty in the complete closure of the eyes.
Treatment:
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Surgical correction involves increasing the vertical height of the eyelid.
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Skin grafts or hard palate grafts can be used for reconstruction.
3. Congenital eyelid Coloboma :
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This condition is characterized by simple notching or aperture in the margins of the upper eyelid.
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It is mainly caused by the failure of the fusion of embryonic lid folds. It can be either unilateral or bilateral.
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It is often associated with Treacher-Collins syndrome (inherited syndrome associated with craniofacial deformities)
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It often causes problems in the lubrication of the eye. In the case of large clefts, there is prominent vision loss.
Treatment:
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In the case of small clefts, simple closure of the eyelid is enough.
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A lateral canthal tendon is used to close the defect in case of moderate-sized defects.
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In case of significant defects, surgical procedures such as the Cutler-Beard procedure (full thickness cutaneo conjunctival eyelid advancement flap) and eyelid rotational flap procedure are used to close the defect.
B. Malformation Caused Due to Eyelid Margins:
1. Distichiasis:
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This condition is characterized by accessory eyelashes, either partial or complete.
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It often causes corneal irritation.
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These are usually shorter, thinner, and less pigmented. It is associated with Steven Johnson Syndrome.
Treatment:
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Electrolysis of eyelashes or cryotherapy
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Direct surgical excision via transconjunctival approach.
2. Ankyloblepharon:
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This is characterized by the partial fusion of the eyelid with the web of skin.
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If seen in the middle of the margin, it is called internal ankyloblepharon. If it is associated with multiple small strands, it is called ankyloblepharon filiforme.
Treatment:
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Surgical excision of the skin using a scalpel or scissors.
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Electrocautery.
C. Malformation of the Position:
1. Blepharoptosis:
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It is characterized by falling the upper eyelid in a lower position than normal, shortening the palpebral fissure.
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Usually, the upper eyelid is one to two millimeters below the superior limbus. But blepharoptosis is more than two millimeters.
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It is caused due to levator muscles. In severe cases, it obstructs vision and amblyopia in children.
Treatment:
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Surgical resection or tucking of levator muscles.
2. Entropin:
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It is characterized by the inward turning of the upper eyelid margin and is usually seen in older adults.
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It is associated with itching, redness, swelling, and rashes.
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Inward lash turns often cause cornea irritation, leading to secondary infection. It should be treated as it often leads to abrasion and corneal ulcerations.
Treatment:
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Eye drops to aid in lubrication.
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Steroid cream.
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Surgical correction in severe cases.
3. Ectropin:
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This condition is similar to entropin; however, the upper lid margin is turned outward.
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It is commonly seen in aged people and associated with redness, dryness, and severe irritation to the cornea leading to conjunctivitis or keratitis.
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It is also seen in conditions such as Bell’s palsy and Down syndrome.
Treatment:
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Eye drops help in lubrication.
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Steroid cream.
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Surgical correction.
4. Coloboma:
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Coloboma is characterized by missing eye fragments impairing one or both eyes.
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It results from abnormal eye development during pregnancy.
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A gap known as the choroidal fissure manifests during the eye-forming process at the base of the stalks that will eventually form into the eyes.
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These holes generally fill by the seventh week of pregnancy, but if they do not, a coloboma will develop.
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Birth colobomas may indicate a syndrome that has not yet been identified.
Treatment:
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Colobomas are frequently treated surgically by doctors.
Conclusion:
Many eyelid problems are generally easily treated with proper care. Most of the disorders resolve once the infection subsides. Still, a few genetic conditions and problems arising due to aging need professional care and sometimes surgical treatment for good vision.
