Eyelid diseases

The chalazion is a nodule that forms on the eyelids due to the obstruction of the ducts of the sebaceous glands (meibomian glands) that are located on the palpebral margin. These glands are responsible for secreting the fatty component of the tear film, and are essential for adequate protection of the ocular surface.

When the duct of any of these glands is obstructed, the fatty secretion accumulates and the body reacts with an inflammatory process that surrounds the gland. Unlike the stye, this is not a primarily infectious process.

The main symptom of a chalazion is the presence of a nodule on the eyelid. It may be painful initially and cause widespread swelling of the entire eyelid.

The most common age of presentation is adolescence. Pregnancy can also lead to the appearance of chalazions. Other risk factors are: Blepharitis, seborrheic dermatitis and acne rosacea.

Approximately 25% of chalazion cases disappear without treatment. Many times a chalazion becomes chronic and requires some type of treatment.

Local heat (e.g., hot cloths) applied several times a day can help unblock the glandular duct. In this phase, antibiotic and corticosteroid ointments are also recommended once or twice a day to reduce inflammation. When a chalazion does not resolve with the above measures, local injection of steroid is recommended. This can easily be done in the office without the need for anesthesia. When a chalazion is resistant to the latter treatment, surgical treatment remains. With local anesthesia, the affected gland can be opened directly and the surrounding scar tissue dried out. This is a minor operation that lasts about 10 minutes. In certain people with very recurrent chalazions or in patients with acne rosacea, treatment with oral doxycycline may be beneficial.

It is the involuntary spasmodic contraction of the orbicularis muscle. It can be caused by an irritative reflex (e.g. conjunctivitis, foreign body) or be due to idiopathic causes. In the cases in which the cause is not known, usually it appears in adults of bilateral form, disappears during the dream and can be accompanied by bucofaciales movements or of head.

An ocular and neurological exploration is required. If it does not disappear, the ophthalmologist will evaluate the treatment with injection of botulinum toxin.

Drooping eyelid or palpebral ptosis is a descent of the upper eyelid that occludes the eyeball in variable proportion. The patient cannot open his or her eyes normally, and it can become difficult to see if the eyelid covers the pupil.

In infantile age the patient is in a moment of development and growth, reason why a lazy eye or amblyopia can be produced.

It can be congenital (uni or bilateral) or acquired. Among the acquired ones, the bilateral ones are usually due to myogenic causes, associated with myasthenia gravis or myotonic dystrophies, or senile (frequently due to alterations in the aponeurosis of the upper eyelid elevator muscle). Those acquired unilaterally can be of traumatic etiology (frequently in contact lens wearers) or neurogenic (for example in the Claude-Bernard-Horner syndrome consisting of ptosis, myosis and hemifacial anhidrosis).

When it interferes with vision or creates an aesthetic problem, its treatment is surgical. In the vast majority of cases, palpebral ptosis is corrected by strengthening the upper eyelid lift muscle, sometimes combined with eyelid remodeling (blepharoplasty).

In case this muscle has very little action, its fall is corrected with the implant of some strips of material (commonly fascia lata) that pull the eyelid from the forehead. This variant of the intervention is called frontal suspension. The intervention is usually done on an outpatient basis with local anesthesia and sedation in adults. In children the intervention is performed under general anesthesia.

These are malpositions of the palpebral margin in which it rotates outwards (ectropion) or inwards (entropion). The consequences of these malpositions are (in addition to cosmetic ones): irritation of the eye surface, tearing and eye redness. As a final result the cornea can end up being seriously damaged as a consequence of ulcers and infections.

The most frequent cause is a weakening of the muscles and tissues which support the eyelid as a consequence of aging. Other causes are facial paralysis and scarring secondary to trauma, burns or chronic inflammation of the skin or conjunctiva.

The treatment is surgical and basically consists of reinforcing the weakened structures and/or replacing the scarred tissues with healthy ones. Until the moment of the intervention, hygienic measures and lubrication are advised to avoid infections and erosions of the ocular surface.

Deviation of the eyelashes towards the inside of the eye, which when rubbing the eyeball produce a sensation of foreign body and red eye. The rubbing on the cornea gives rise to superficial spotted keratitis.

The causes are idiopathic or secondary to chronic blepharitis.

It is treated by tweezing the deviated eyelashes and in rebellious cases cryotherapy.