The eyelids are much more than just the “gate” to the eye – they protect the eyeball, maintain proper moisture, and play an important role in both vision function and facial aesthetics.
When eyelid diseases develop, the impact is not merely local: quality of life, external appearance, and sometimes even vision itself can be affected.
In this page, we’ll discuss common eyelid conditions, how they manifest, when medical treatment is necessary, and what solutions the field of oculoplastics offers for accurate and effective care.
The eyelids are the primary protective organ for the eye and its external surface, enabling clear and proper vision.
The upper eyelids are more significant than the lower ones, but the lower eyelids also play a vital role in maintaining eye health and ensuring comfort.
The eyelids are composed of several anatomical layers. The outermost layer contains skin and eyelashes, directly beneath which lies the orbicularis oculi – a facial expression muscle whose proper function is essential for full eyelid closure and normal blinking (typically 12–15 blinks per minute).
Blinking is responsible for removing waste materials from the surface of the eye and evenly distributing the tear film to maintain sharp, healthy vision. It also facilitates the drainage of tears from the eye.
People suffering from facial nerve paralysis – such as Bell’s palsy – often experience incomplete eye closure (lagophthalmos) and reduced blinking. These conditions can lead to dryness, a foreign body sensation, pain, blurred vision, and sometimes even infectious inflammation.
Beneath the skin in the central part of the eyelid lies the tarsal plate – a collagen-rich tissue that forms the rigid framework of the eyelid. It contains the Meibomian glands, which are responsible for secreting the oily component of the tear film.
Above it is the orbital septum, a tough connective tissue that protects the eye from trauma and infection. Beneath the septum lies the orbital fat.
The outer surface of the eye and the inner surface of the eyelid are lined with conjunctival mucosa, which is essential for maintaining moisture and enabling healthy blinking. This tissue also contains additional tear glands and cells that secrete another oily component of the tear film.
A healthy anatomical relationship between the eyelid and the eye, structural integrity of all eyelid layers, and proper blinking are all vital for preserving ocular health and clear vision.
Therefore, trauma or disease affecting the eyelids can lead to blurred vision, pain, and eye infections.
A deep understanding of eyelid structure and function is essential for the successful treatment of eyelid conditions and surgical procedures involving the eyelids.
The term “eyelid diseases” refers to a wide range of medical conditions that affect the tissues of the eyelid – from the outer layers (skin and glands), through the muscles, and down to the inner margins adjacent to the eye itself. These diseases can be inflammatory, infectious, degenerative, congenital, or acquired, and in some cases, may even indicate a systemic condition.
Some eyelid diseases develop slowly and almost imperceptibly, while others appear suddenly with noticeable symptoms such as swelling, pain, tearing, irritation, drooping, or growths.
Any change in the eyelids – whether aesthetic or functional – requires accurate diagnosis.
Eyelid diseases can result from a variety of causes:
Bacterial, viral, or chronic inflammations
Recurrent irritation due to dry eyes or allergies
Blockages in the eyelid’s oil glands (such as a chalazion)
Local trauma (injuries or previous surgeries)
Degenerative changes related to aging
Benign or malignant tumors
Autoimmune or systemic diseases
In addition, there are hereditary or congenital conditions that can affect the structure and function of the eyelids — such as congenital ptosis or anatomical deformities.
Among the general population, several eyelid conditions appear frequently:
Blepharitis
A chronic inflammation of the eyelid margins. It is usually caused by bacteria or dysfunction of the oil (Meibomian) glands.
Patients often report a gritty sensation in the eyes, itching, redness, and sometimes a white crust in the morning.
Hordeolum (Stye) and Chalazion
An infection or blockage of an oil gland, presenting as a red and sometimes painful bump on the eyelid.
While a hordeolum typically resolves on its own or with antibiotic treatment, a chalazion may require surgical drainage.
Benign Essential Blepharospasm
This condition is characterized by involuntary eyelid blinking of varying severity. It is often associated with dry eyes and sometimes with eyelid drooping (ptosis).
In mild cases, the issue is mainly cosmetic, but in more severe cases, the frequent blinking can interfere with vision. Some patients may also experience difficulty opening their eyelids (Apraxia of Eyelid Opening).
Thanks to Botulinum toxin (BOTOX), this condition can now be treated with simple injections into the affected muscles. Initial doses are low and gradually adjusted to achieve the desired reduction in involuntary blinking. Repeat injections are needed every few months.
In more severe, non-responsive cases, surgical removal of the orbicularis muscle (Orbicularis Myectomy) may be performed to reduce blinking severity.
Trichiasis
A condition in which the eyelashes grow abnormally, turning inward toward the surface of the eye and cornea. These lashes can cause irritation and small abrasions on the cornea and eye surface.
Patients typically report a foreign body sensation, redness, and tearing.
Trichiasis is usually secondary to other conditions such as childhood trachoma, previous eyelid surgeries, trauma, chemical burns, or chronic eye infections – but it may also appear as a primary condition.
Ptosis
Drooping of the upper eyelid, which may result from muscle paralysis, trauma, aging, or congenital causes.
Beyond cosmetic concerns, ptosis can impair the visual field and become a significant functional issue.
Dermatochalasis
Excess skin on the eyelids – a common age-related condition, though it can also be hereditary.
It may cause a tired appearance, reduced visual field, and in some cases, recurrent inflammation.
Under normal conditions, the eyelashes on the lower eyelid face outward. Entropion is a condition in which the edge of the lower eyelid turns inward toward the eye, causing the lashes to rub against the outer surface of the eye. It typically appears in older adults and results in noticeable eye irritation, redness, foreign body sensation, pain, tearing, and blurred vision.
Entropion is usually caused by weakness of the muscles that support the lower eyelid, as well as laxity of the tendon that connects the eyelid to the lateral orbital wall.
It is important to differentiate this from a similar condition in children called epiblepharon, where the eyelashes grow vertically and come into contact with the outer eye surface. In most cases, this condition resolves without surgery. Surgery may only be considered if there is no improvement – involving removal of excess lower eyelid skin and repositioning or reattachment of the lower eyelid muscle.
Ectropion, or outward turning of the lower or upper eyelid, results from tendon weakness, excessive eyelid laxity, and horizontal muscle weakness, causing the eyelid margin to turn outward. This condition presents with symptoms similar to entropion, though usually less severe. It may also be accompanied by chronic conjunctival redness and prolonged eye inflammation.
If the condition causes significant discomfort or functional issues, surgical correction of the eyelid position may be considered, or botulinum toxin injection as a temporary treatment for entropion.
Basal Cell Carcinoma (BCC) – is the most common eyelid tumor, with the lower eyelid being the most frequently affected site.
Although the tumor is malignant, it rarely metastasizes. Its growth is very slow, often developing over several years, and it tends to be locally invasive or locally destructive.
The most effective treatment is complete surgical excision of the tumor with clear margins. This is typically performed with intraoperative frozen section margin control, followed by eyelid reconstruction.
Depending on the size of the defect after removal, primary closure may be possible. However, in many cases, a tissue graft from another source – such as the upper eyelid, skin, or oral mucosa – is required.
In cases of extensive or locally invasive BCC, biologic therapy with Vismodegib may be considered.
Squamous Cell Carcinoma (SCC)
The second most common eyelid tumor is Squamous Cell Carcinoma (SCC), and its surgical treatment is similar to that of BCC.
However, SCC tends to be more aggressive and has a higher tendency to spread along nerves around the eye and orbit.
In all cases, after tumor excision and reconstruction, regular follow-up with an oculoplastic specialist is essential to monitor for recurrence.
As with BCC, biologic treatment may be considered in cases of extensive or invasive SCC.
The first step in treatment is an accurate diagnosis. A general ophthalmologist can identify early signs, but an oculoplastic specialist with experience in eyelid surgery will be able to assess the findings comprehensively and recommend a tailored treatment plan.
The diagnostic process includes:
Clinical examination of eyelid appearance and function
Visual field testing
Imaging (CT / MRI) in complex cases
Biopsy or referral for histopathological analysis in the case of a suspected tumor
Treatment depends, of course, on the specific diagnosis, but it can generally be divided into two main categories:
Conservative Treatments:
Daily cleansing of the eyelid margins
Warm compresses
Antibiotic eye ointments
Eye drops for dryness or inflammation
Insertion of punctal plugs for dry eye relief
Botox injections and dermal fillers for functional and aesthetic enhancement of the eyelids
Antihistamines or steroids (for allergy or severe inflammation)
Surgical Treatments:
Surgery to remove a chronic chalazion
Ptosis repair surgery
Removal of excess skin from the upper or lower eyelids (blepharoplasty)
Fat contouring or autologous fat grafting in the upper/lower eyelids
Surgeries to correct ectropion or entropion
Excision and reconstruction of tumors
In cases where eyelid diseases also affect facial aesthetics, it’s possible to combine medical treatment with precise cosmetic solutions – for example, medical blepharoplasty, which improves both visual field and facial appearance.
Not necessarily. Many lumps (such as a chalazion) are benign, but it’s important to have any new lump that doesn’t resolve within a few weeks evaluated.
A stye is an acute inflammation of an oil gland, usually accompanied by pain and redness. A chalazion is a chronic response to a blockage, typically painless and felt as a firm internal lump.
Not always, but when there is a visual field obstruction or significant cosmetic concern, surgery is the most effective solution.
When an eyelid condition (such as ptosis or dermatochalasis) affects the visual field, the surgery is considered medical and may even be covered by health insurance providers.
The decision depends on the degree of medical or cosmetic impact. If the ectropion is mild and not bothersome, surgery is not necessarily required. In many cases, conservative treatment – such as managing dry eyes, associated eyelid inflammation, or conjunctivitis – can lead to significant improvement.
However, when ectropion is more severe and accompanied by recurrent eye infections, tearing, foreign body sensation, or eye pain, surgical correction is a valid and effective option. The procedure is performed under local anesthesia and has a very high success and improvement rate.
Botox injections can be used for temporary relief in cases of entropion.
It depends on the type of condition. For example, blepharitis tends to be chronic and requires ongoing maintenance, while ptosis is usually fully resolved with surgery.
A BCC (Basal Cell Carcinoma) tumor is generally not dangerous, does not metastasize, and tends to grow and spread slowly. In certain cases – when the tumor is small and located in the center of the eyelid, away from the tear drainage system – observation may be considered.
However, if the tumor is widespread, growing relatively quickly, or located near the tear ducts, surgical excision and reconstruction is recommended as soon as possible. Surgical outcomes are typically very good, with minimal aesthetic or functional impact.
In cases of locally invasive BCC, biologic therapy with Erivedge (Vismodegib) may be considered, under the care of an oncology specialist.
Eyelid diseases may sometimes seem minor, but in reality, they can affect quality of life, vision, and self-confidence.
Proper treatment begins with a professional diagnosis by an eyelid specialist – particularly one who combines clinical expertise with precise surgical skills.
Professor Guy Ben Simon, a world-renowned expert in oculoplastic surgery, offers a unique blend of deep medical knowledge, years of experience, and the ability to perform complex eyelid treatments and surgeries – all while preserving natural appearance, full functionality, and respecting the delicate nature of the area.
If you’re experiencing symptoms or notice any changes in your eyelids – now is the time to schedule a consultation and avoid postponing care.
MEDICA Medical Center, HaBarzel 28, 1st floor, Ramat HaHayal, Tel Aviv
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