Jamie L. Zucker, MD, is Assistant Clinical Professor, Northeastern Ohio University College of Medicine, Canton, Ohio.
Disclosure: The author states that he has no conflicting interests to disclose.
ABSTRACT
The eyelids, essential to protecting and cleansing the eye, are a common site for a range of disorders affecting older adults.
Some of these are benign and some serious, with the most clinically important being suspicious lid lesions that may harbor
malignancy and neurologic disorders, as well as structural malpositions that cause poor lid function and may lead to globe
damage and visual impairment. The ability to recognize eyelid problems is important, as they often present first to the primary
care physician. Some eyelid disorders can be successfully treated quickly and easily in the office setting, whereas others
may be chronic and more difficult to manage, requiring referral to an ophthalmologist or oculoplastic specialist. Zucker JL. The eyelids: Some common disorders seen in everyday practice. Geriatrics. 2009;64(4):14-19, 28.
Key words: blepharitis, ectropion, entropion, eyelids, hordeolum, malignancies, ptosis, retraction
Drugs discussed: betamethasone, botulinum toxin, cephalexin, dexamethasone/neomycin, doxycycline, erythromycin, hydrocortisone,
penicillin V potassium, pyridostigmine, sulfacetamide/prednisolone, tobramycin/dexamethasone
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The eyelids are a common site for a range of disorders affecting older adults, from simple inflammation (blepharitis) to potential
life-threatening malignancies. Some problems are localized and self contained, whereas others are systemic entities that secondarily
affect the eyelid tissue and function. These amazing complex structures, with many tissue layers, provide a unique and vital
function in lubricating, protecting, and cleansing the underlying eyeball, which makes them essential for good vision. The
ability to recognize eyelid problems is important, as they often present first to the primary care physician (PCP). Some eyelid
disorders can be successfully treated quickly and easily in the PCP's office, whereas others may be chronic and more difficult
to manage, requiring referral to an ophthalmologist or oculoplastic specialist.
This article gives an overview of the form and function of the eyelid complex and presents common eyelid disorders and their
treatments. The information provided herein should help the PCP decide when simple in-office treatment is indicated or when
surgery or referral is necessary.
Eyelid physiology
The eyelid is a multipurpose, multistructured tissue that mainly provides protection and lubrication to the underlying eye.
It not only furnishes some components of the tear film through the meibomian glands and conjunctival surface but also sweeps
dirt, debris, and toxins away from the eye by the normal blink function. The eyelashes help keep foreign material away from
the eyes, and the blink also forces tears into the tear ducts and thus circulates a clean tear film over the eye. The tear
outflow system lies within the nasal eyelids; patency of this system is needed to maintain normal circulation of tears and
prevent excess tearing.
The eyelid is composed of many different tissue types including skeletal (orbicularis oculi) and smooth muscle tissue (Mueller's
muscle); sebaceous, mucous, and sweat glands; eyelashes; fibrous tarsal plate; skin; and a mucous membrane (the conjunctiva).
The blink and tear functions are both controlled by voluntary and involuntary neurologic responses. The eyelid complex is
marvelously engineered and easily taken for granted but can cause tremendous problems for patients when not working properly.
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