Eyelid Problems: Causes and Fixes

Most eyelid issues aren’t serious. But if you’ve noticed something’s different about one or both of your eyelids, it’s important to know what to look out for.

Asymmetrical Eyes

Faces aren’t even (or “symmetrical”). So if your eyelids aren’t the same size or don’t look the same, that’s normal. But in rare cases, uneven eyelids can be a sign of another health problem, like a thyroid disorder, for example. So if you're concerned, talk with your doctor.

Treatment options: If it's only about appearance, you can try using makeup to make your eyes look more even. If your eye problem is a sign of a more serious issue, your doctor may recommend medicine or surgery to treat the underlying problem. That might also help you feel better about how you look.

Blepharitis

If you have blepharitis, your eyelids are inflamed. This can make them red, swollen, or itchy. Blepharitis can also cause watery eyes. A bacterial infection can trigger it, as can skin conditions like rosacea or issues with the oil glands near your eyelids.

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Treatment options: Your eye doctor may prescribe steroid eye drops or recommend that you use artificial tears. Cleaning your eyelids with a warm washcloth can also help.

If an underlying condition causes your blepharitis, treating that may help ease your inflamed eyelid.

Blepharochalasis

This is when the skin of your eyelid begins to droop. Age usually causes it, though genetics may play a role, too.

Treatment options: The only way to correct blepharochalasis is by having a surgery called blepharoplasty. It removes some of the drooping skin. If blepharochalasis is interfering with your vision, your health insurance company might pay for surgery.

Blepharospasm

This means your eyelids spasm or blink involuntarily. Eyelid twitching is common and is usually a sign that you’re under stress or tired. But if your twitching or blinking is constant and gets worse over time, you may have blepharospasm. It can also cause facial twitching, exhaustion, and sensitivity to light. Abnormal activity in an area of your brain called the basal ganglion can cause it. The basal ganglion is responsible for muscle control.

Treatment options: There’s no cure for blepharospasm. But research shows that using botulinum toxin (Botox) around your eyelids can give you less spasms. A surgery called myectomy, which removes some muscles and nerves in your eyelids, can also help ease symptoms.

Chalazion

A chalazion is a swollen bump on your eyelid. It’s usually painless, but it can be as big as a pea or small grape. A chalazion can cause your eyelid to droop over your eye, too. A clog in an oil gland is the cause. It may start as a stye but turn into a chalazion as it grows larger.

Treatment options: Warm compresses to your eye several times a day can ease swelling. If your chalazion is very large or swollen, your doctor may recommend antibiotic eye drops, steroid shots, or even a surgical procedure to drain the chalazion. Never try to pop or drain it on your own.

Dermatochalasis

This is when the skin and muscle of your eyelids become droopy. This can sometimes cause vision problems or contribute to other issues, like a rash. Age-related loss of elasticity in your skin and connective tissues can cause it. Other conditions can bring it. Genetics may play a role, too.

Treatment options: Cosmetic procedures like laser resurfacing or chemical peels may help things look a little better. But the only way to completely correct it is through blepharoplasty surgery, which removes excess skin.

Ectropion

Ectropion means the muscles of your lower eye lid get weaker. This can make your lid sag and turn “out” and away from your eyeball. Then your upper and lower eyelids can't close completely, making it hard or impossible to completely close your eyes. When your eyelids don’t close, you may get dry eyes and irritation.

Treatment options: If your ectropion is mild, you may not need treatment. But if you have dry, irritated eyes, your doctor may tell you to use artificial tears or a plastic eye shield at night. Both things can help protect your eye and lock in moisture. If your ectropion is severe, your doctor may recommend surgery to tighten the skin and muscles of your eyelid.

Entropion

This is similar to ectropion. But instead of rolling out, your lower eyelid rolls in toward your eyeball. That can make your eyelashes rub against your eyeball and irritate it. If you have entropion, your eyes may tear up a lot, blur, or feel extremely irritated.

Treatment options: If you have mild entropion, your doctor may recommend you tape your lower eyelid to your cheek at night to prevent irritation. But if your entropion is more severe, your doctor may want you to get surgery to tighten the muscles and skin of your eyelid so that it closes normally.

Graves' Eye Disease (also called Thyroid Eye Disease)

This is an autoimmune condition that happens when your immune cells attack your thyroid gland (a butterfly-shaped gland in your neck), causing it to create too much thyroid hormone. That can trigger your immune system to attack the tissue around your eyes. When that happens, your eye muscles and the fat in your eyes can expand. That will make your eyes and eyelids bulge. Your eyelids might not close all the way.

Treatment options: Since Graves' eye disease can affect your vision, your doctor will monitor your eyes and will recommend a plan to protect your sight. For example, artificial tears or other gels or ointments can prevent dryness and irritation. Using eye covers or taping your eyes closed at night may help, too. In some cases, your doctor may want you to use steroids to ease inflammation. If you have tight, painful eyelids, your doctor may recommend surgery to help get your eye back to a normal position.

Pinkeye (Conjunctivitis)

Pinkeye happens when inflammation or infection hits the membrane lining your eyelid and the whites of your eyeballs. Either way, your blood vessels to become inflamed and your lids and eyes look pink. It can also make your eyes itchy, painful, or have a “gritty” feeling. Babies can also get it if they have a tear duct that doesn’t open all the way.

Treatment options: Pinkeye usually goes away on its own after several days to a few weeks. In the meantime, you can make yourself more comfortable by using artificial tears and putting a cold or warm compress on your closed eyes several times each day. If you wear contacts, you’ll need to stop wearing them until your pinkeye clears. If allergies cause your pinkeye, your doctor may recommend you use allergy drops in your eyes.

Ptosis

Ptosis is similar to blepharochalasis. But sagging muscles under your eyelids causes it, not sagging skin. Eye injuries, diseases like diabetes, and problems with your nervous system can cause ptosis. In some cases, Botox shots to take away wrinkles can contribute to ptosis, too.

Treatment options: If Botox caused your ptosis, the sagging will go away after the toxin wears off. In other cases, you may need to have surgery to remove excess skin and lift your eyelid. Your health insurance may cover surgery if ptosis is making it hard for you to see.

Stye

A stye (also called a hordeolum) is a small swollen bump that looks like a pimple or boil on your inner or outer eyelid. It may be solid, or it might ooze pus. It’s usually not painful. An infection in the oil gland of your eye usually is the cause.

Treatment options: Most of the time, styes go away on their own. But until it does, you can put a warm washcloth over your eye several times a day. You should wash your eyelid with a mild soap and warm water, too. Make sure you don’t put makeup on your eye or use contact lenses until the stye is gone. Never try to pop or drain a stye on your own. If your stye doesn’t go away after a week or so, see your doctor. They may recommend antibiotic eye drops or creams or a minor surgical procedure to drain the pus and ease the pressure.

Xanthelasma

Xanthelasma are bumps on your eyelids filled with cholesterol. They’re usually yellowish. You’re more likely to have them if your cholesterol or triglyceride levels are high. Primary biliary cirrhosis, an autoimmune condition that affects your liver and bile system, can cause xanthelasma, too.

Treatment options: It’s important to see your doctor if you notice yellow bumps on your eyelids because this can be a sign that you have a higher chance of heart disease. Your doctor may recommend tests to check your cholesterol and triglyceride levels and to see how well your heart works. If you want the bumps removed, your doctor may recommend cryotherapy (freezing the area with liquid nitrogen), lasers, surgery, or other methods. Removing xanthelasma can cause scarring. It also doesn’t keep new xanthelasma from forming.

WebMD Medical Reference Reviewed by Whitney Seltman on July 11, 2020

Sources

SOURCES:

NHS U.K.: “Eyelid problems."

Harvard Medical School HealthBeat: “The aging eye: when to worry about eyelid problems,” “Ask the doctor: What can I do about xanthelasma on my eyelids?”

University of Michigan Health System: “Eyelid problems.”

National Eye Institute: “Blepharospasm.”

Mayo Clinic: “Sty,” “Pinkeye.”

Oklahoma Otolaryngology Associates: “Causes of Uneven Eyes and Its Treatment.”

UC San Diego Health: “Dermatochalasis.”

American Academy of Ophthalmology: “Dermatochalasis,” “What Are Chalazia and Styes?”

Michigan Medicine Kellogg Eye Center: “Thyroid Eye Disease (TED or Graves’ Eye Disease).”

Andrea Thau, OD, associate clinical professor emerita, SUNY State College of Optometry; past president, American Optometric Association.

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