Entropion
Presentation
- Inversion of the upper or lower eyelids
- Main problem is due to the eyelashes rubbing against the eye, causing irritation and pain
- In severe untreated cases, corneal damage can occur, affecting vision
- Incidence increases with age
- Very rarely can be congenital
Management
- Taping the eyelid to the cheek may help
- Plucking the eyelashes can lessen the irritation
- Lubricating eyedrops may help to alleviate irritation
- Botulinum toxin injections have been used successfully
- In many cases, surgery is required
Blepharitis
Presentation
- Blepharitis is a condition of inflammation of the eyelids
- The eyelid margins are most commonly affected
- Usually a chronic condition affecting both eyes
- Three main types are seborrhoeic blepharitis, staphylococcal blepharitis and meibomian blepharitis
- All three produce symptoms of soreness and irritation
- Eyelids may look greasy and stick together in the mornings
- Fine scale is often present
Management
- No cure, but regular treatment will keep it under control
- The mainstay of treatment is eyelid hygiene
Ectropion
Presentation
- Occurs when the eyelid loses contact with the eye and everts
- Common condition of the elderly, caused by laxity of muscles and skin
- Lower eyelid mostly affected
- The affected eye tends to water constantly
- Loss of lubrication by tears may result in palpebral keratinisation and corneal damage
Management
- Taping the eyelids closed may prevent drying overnight
- Lubricating drops can help to protect the cornea
- Treatment is usually by surgery to tighten the eyelid
Contact dermatitis
Presentation
- Most commonly caused by cosmetics and therapeutic eyedrops
- May occur secondary to nail varnish touching the eyelids
- Pruritis suggests an allergic cause; burning and stinging, an irritant cause
- Oedema and scale may be seen
Management
- Ideally, remove the cause
- Cold compresses can be applied directly to the eyelids
- Emollients should be applied on a regular basis
- Low-potency topical steroids in more severe cases
- Pimecrolimus is a steroid-free alternative
Dr Stollery is a GP in Kibworth, Leicestershire, and clinical assistant in dermatology at Leicester Royal Infirmary
