Eyelid Diseases

Why are our eyelids important?

The eyelids are responsible for protecting the eye. They protect the eye against foreign objects. They ensure homogeneous distribution of tears on the cornea and conjunctiva layers on the outermost surface of the eye and prevent the eye surface from drying out. They also regulate the amount of light coming into the eye together with the pupil.

Structure of the eyelids

There are mainly 7 layers in the structure of the eyelids.

Skin and subcutaneous connective tissue

Muscles responsible for closing the lids

Orbital septum

Orbital fat

Muscles responsible for opening the lids



The eyelid skin is the thinnest skin on our body and, unlike other areas, has no fatty tissue under the skin. Just below the skin and subcutaneous connective tissue there is the orbicularis oculi muscle, which is responsible for closing the eyelids. It circumscribes the eyelid and is divided into pretarsal, preseptal and orbital divisions according to its location. It also contributes to the absorption of tears during eye opening and closing. Deep to the orbicularis muscle there is hard tarsus tissue, which extends from the ciliated end of the eyelids upwards in the upper lid and downwards in the lower lid. In addition to serving as a skeleton for the lids, it also houses the meibomian glands, which produce the lipid (oil) layer of tears. One end of the tarsus is at the ciliated margin, while the other end is attached to the muscles responsible for opening the eyelids. These are the levator palpebra superioris and Müller muscle in the upper lid and the lower eyelid retractors originating from the inferior rectus muscle fascia in the lower lid. The innermost layer of the lids is covered by the conjunctiva. There is a fibrous orbital septum that extends from the edge of the orbital bones towards the tarsus and adheres to the muscles that open the lids, and behind it there is orbital fat tissue.

The difference in eyelids in some races, for example the difference in eyelids and lid folds between Asian and Caucasians, is due to the difference in the location of the septum and orbital fat. The orbital septum separates the eyelids from the orbit and limits the spread of infection and bleeding.

What are the most common eyelid diseases?

Eyelid diseases can be congenital, acquired, inflammatory or tumoral. Symptoms and treatment methods for some common eyelid diseases are summarized below.

Congenital diseases of the eyelid

Congenital eyelid diseases can be seen alone or as a part of some facial or body syndromes.

Blepharophimosis-ptosis-epicanthus inversus syndrome

It is also called blepharophimosis syndrome. It is often inherited in an autosomal dominant pattern, so there are family members with a similar eyelid appearance.

Blepharophimosis is a narrowing of the eyelid opening, accompanied by a droopy eyelid (ptosis), a fold of skin extending from the lower lid to the inner corner of the eye (epicanthus inversus) and a greater than normal distance between the two medial canthi (telecanthus). In addition to the typical findings, the eyelid may also be turned outward, high arched eyebrows, flattening of the nasal root and ear disorders may also be seen. Surgical correction is performed gradually in the treatment.

Congenital ptosis

Congenital drooping of the upper eyelid. It is usually caused by a developmental defect of the levator palpebra superioris muscle.

The eyelid cannot be lifted sufficiently due to a defect in the contraction of the muscle; at the same time, the relaxation of the muscle is defective and the eyelid cannot be lowered sufficiently when looking down. The upper eyelid fold (skin crease) is usually absent or more faint than the healthy eye.

In some children, strabismus may also be associated. Droopy eyelids block vision by closing the pupil or increase astigmatism by compressing the eye even if the pupil is open. In addition, cosmetically asymmetrical eyelids and a different facial appearance from peers affect the child’s socio-cultural development.

In the presence of advanced ptosis, which carries a high risk for reduced vision (lazy eye, amblyopia), surgical treatment is applied in the early period. In milder cases, astigmatism and amblyopia are primarily treated with glasses and closure therapy. When the child reaches school age (5-6 years), surgical correction is performed. Different surgical options can be applied depending on the deficiency in the function of the levator palpebra superioris muscle.

Infantile (capillary) hemangioma

It is a vascular tumor of the eyelid. It becomes prominent 1-2 weeks/months after birth, grows in the first year of life and shrinks in the following 3-7 years. Lesions that are not large enough to interfere with vision are followed up and are expected to shrink and disappear with the natural course. Large lesions or lesions that interfere with vision due to location can be treated medically/surgically.

Nevus flammeus (port wine stain).

It appears as a flat, pink lesion consistent with the area innervated by the trigeminal nerve branch. It may be part of Sturge-Weber syndrome. There is no spontaneous resolution, but laser treatment can be applied to improve the external appearance.


Congenital ectropion or entropion, ankyloblepharon (partial or complete adhesion of the eyelids), epiblepharon (horizontal skin fold on the lower lid that pushes the eyelashes), epicanthus (skin fold covering the inner corner of the eye – medial canthus), ankyloblepharon (sagging eyelid), coloboma (partial or complete absence of part of the lid), cryptoophthalmus (complete or partial underdevelopment of the eyebrow, eyelid, eye opening, eyelashes and conjunctiva) are other rare congenital eyelid diseases.


Acquired diseases of the eyelid


It occurs when the meibomian gland orifices become blocked, causing secretion to back up and triggering an inflammatory reaction. The meibomian glands are located vertically in the tars on both eyelids and produce an oily secretion that is released from the ciliated margin to form the lipid layer of the tear.

When the orifice of the glands is blocked, secretions accumulate in the tarsus, causing an inflammatory reaction, pain and redness. Hot compresses, massage, topical antibiotics and anti-inflammatory drops are used in the early stages.

In the late period, the chalazion is surgically removed. In the presence of frequently recurring chalazion; underlying skin disease (Rosacea) or chronic eyelash inflammation (blepharitis) should be investigated.

Stye (Hordeolum)

It is often a bacterial infection. It can affect the sebaceous glands (outer hordeolum) or the meibomian glands (inner hordeolum) of the lid. It usually resolves spontaneously and warm compresses and antibiotic ointments are helpful. Rarely, the infection may spread to the tissues around the eye or abscess formation can be seen.


It is the inward turning of the eyelid. It can develop due to age-related, spastic or scatricial causes. An inverted eyelid causes the eyelashes to come into contact with the surface of the eye and causes a severe stinging sensation. Redness and watering of the eye are observed. In the following period, permanent vision loss may develop due to damage to the transparent cornea layer. Treatment may include moisturizing drops and gel, bandage contact lenses, eyelash removal/burning, rotating stitches or surgical correction.


It is the outward turning of the eyelid. It may be related to aging or may occur due to scatricial, paralytic or mechanical causes. Although the symptoms may differ depending on the cause, stinging, discomfort, redness, hardening and redness of the conjunctiva develops. In addition to medical agents (such as moisturizing drops or gel), surgical correction is performed.


It is the drooping of the upper eyelid. Acquired ptosis may occur due to myogenic, aponeurotic, neurogenic, mechanical or traumatic causes. It causes narrowing of the upper visual field, ptosis often becomes more obvious when looking down and may cause difficulty in reading. In addition, as the amount of light entering the eye decreases, visual acuity may decrease, especially in dim light and at night. During the examination, the main points of interest are the eyelid opening, skin fold, function of the levator palpebra superioris muscle, signs of corneal exposure, accompanying eye, eyebrow and facial findings and treatment is planned accordingly.

Eyelid retraction

The eyelid retraction is defined by abnormally high resting position of the upper eyelid or low resting position of the lower eyelid. It can be seen in local, systemic or central nervous system related diseases.

The most common cause is eye involvement due to thyroid disease. In healthy individuals, the upper eyelid covers the colored part of the eye by 1-2 mm and the lower eyelid is tangential to the colored part of the eye.

Excessive opening in the upper and/or lower eyelid leads to more air contact with the eye and dryness symptoms.

Removal of excess skin tissue, especially from the lower lid during lid aesthetics, may cause lower lid retraction and incomplete closure of the eye. Depending on the underlying cause, surface moisturizing treatments, botulinum toxin injection or surgical correction can be applied.

Benign essential blepharospasm

Involuntary contractions in the muscles around the eyes. It is most common in women over the age of 40. Uncontrolled blinking or forceful closing of the eyes can lead to limitations in activities of daily living, individuals may have difficulty driving, watching television, reading books.

After excluding underlying neurologic disease or ocular surface diseases, botulinum toxin injection is applied and is often beneficial. In individuals where treatment is ineffective, surgical options or muscle relaxants may be used.

Ocular myokymia

Twitching of the eyelids. It can be caused by excessive caffeine-nicotine use, fatigue, vitamin deficiency or anemia, and rarely, it can be seen in some neurological diseases.

Benign Tumors of the Eyelid

Squamous papilloma (Flesh mole)

It is the most common benign tumor of the eyelid. They are often brightly colored, stalked or sessile skin projections on the lid margin. Surgical excision is sufficient in its treatment.

Cutaneous horn

It is a keratin deposit that can be seen in many tumoral formations.

It is actually not a diagnosis but a finding. The important thing is to clarify the pathology that causes it by taking a biopsy.

Seborrheic keratosis

They are oily, brown, plaque-like lesions adhering to the skin, usually seen in advanced ages. Although they are not premalignant (precancerous) lesions, their large number or rapid increase in number may be a warning sign for malignancies in other parts of the body. Surgical excision is sufficient for treatment.


It is observed as a nodule with a keratin deposit in the center, which grows rapidly within weeks on sun-exposed skin areas of older individuals. They may disappear spontaneously within 6 months with follow-up.

However, since some pathologists consider them as a low-grade variant of squamous cell carcinoma, complete surgical excision is recommended.

Actinic keratosis

These lesions, which appear as numerous papules with white crusts on sun-exposed areas, are the most common premalignant (precancerous) lesions of the skin. Because of the risk of transformation into squamous cell carcinoma, treatment should include complete excision or cryotherapy.

Epidermal inclusion cyst

They are mobile, hard, round, subcutaneous masses that are formed as a result of implantation of the epidermis into deep tissues, usually after trauma. Excision of the entire cyst wall is recommended in treatment.

Pilar cyst

Although it is clinically very similar to epidermal inclusion cyst, it is observed where hair follicles are present and differentiation can only be made by pathologic examination. Complete excision is recommended in treatment.

Epidermoid and dermoid cysts

They are painless masses that are usually located on the outer part of the eyelid and grow slowly over time. Cysts under the skin can move towards the orbit and there are also dumbbell-shaped cysts with one part inside the orbit and the other part under the skin. The treatment is to remove the cyst wall completely without bursting it if possible. However, due to the risk of orbital extension, it is useful to perform imaging before surgery.


They appear as hard, multiple lesions originating from sebaceous glands. They are usually seen on the eyelids and cheeks. Treatment is surgical excision or drainage of the contents by puncture.

Zeis cyst

They are caused by blockage of the ducts of the sebaceous glands (Zeis) located on the ciliated margin of the lid. The treatment of these cysts with oily, yellowish contents is surgical excision.

Moll’s cyst (Apocrine hydrocystoma)

They occur when the ducts of the Moll’s glands, another gland located on the lid ciliated margin, become blocked and the gland swells. Since Moll’s glands are apocrine sweat glands, their fluid content may be transparent or milky. Surgical excision is sufficient for treatment.

Eccrine hydrocystoma

They are seen as a result of the sweat glands in the skin of the lid not being able to empty their contents and swelling. Their contents are similar to Moll’s cyst. Surgical excision is sufficient for treatment.


Syringomas originating from sweat glands are seen as multiple, small nodules, predominantly on the skin of the lower lid. They are mostly seen in young females and their treatment consists of surgical excision, radiofrequency or electrocautery destruction.

Pyogenic granuloma

It is a bright red-pink vascular lesion that grows rapidly after trauma or surgery and bleeds easily with touch. Surgical excision is sufficient in treatment.


They appear as multiple, soft, shiny lesions on any skin area. Plexiform neurofibroma associated with neurofibromatosis 1 causes upper eyelid drooping (ptosis) and an “S” shaped deformity of the lid. On palpation, it gives the sensation of “worms sliding under the finger”. Surgery can be used as treatment, but the lesions are usually very extensive and may recur.


They usually appear as soft, yellow plaques raised from the skin in the medial (inner) regions of the eyelids of middle-aged to elderly individuals. Since they may be associated with hyperlipidemia, it is useful to check the blood lipid levels of affected individuals. Although surgical excision and laser ablation can be performed as treatment, recurrences are common.


It is frequently seen in light-skinned and tanned people exposed to the sun. They appear as numerous, small, brown macules. They do not require treatment, only sun protection is recommended.

Molluscum contagiosum

They appear as raised, shiny, cheesy, umbilicated nodules with a cheesy content, resulting from a viral skin infection. They occur in large numbers and in combination in AIDS patients. They usually disappear spontaneously within 3-12 months. However, simple excision, incision-curettage, cryotherapy or electrodestruction can be applied to accelerate healing, prevent transmission to other individuals and prevent complications.

Malignant tumors of the eyelid

Basal cell carcinoma

Basal cell carcinoma is the most common malignant eyelid tumor. Being light-skinned, having blue eyes, smoking and prolonged exposure to sunlight during childhood/youth are risk factors for the development of basal cell carcinoma.

It is most commonly localized in the medial region of the eye and lower lid. It appears as a raised and hard mass and may develop vascular structures or ulcers.

Squamous cell carcinoma

The second most common malignant tumor of the eyelid is squamous cell carcinoma, which is more aggressive than basal cell carcinoma and has a high risk of metastasis.

Sebaceous gland carcinoma

Sebaceous carcinoma or sebaceous gland carcinoma originates from the eyelid glands and is a highly aggressive tumor.

Malignant melanoma

Malignant melanoma accounts for 1-2% of all skin lesions and 0.1% of eyelid tumors, but is responsible for 75% of deaths due to skin cancer. After the age of 20, all newly formed pigmented skin lesions should be considered suspicious for melanoma. The presence of light-dark areas of variable color, irregular borders, growth, ulceration or bleeding on any mole should be a warning sign for melanoma.


Kaposi’s sarcoma and Merkel cell carcinoma are rarer eyelid tumors.


The treatment of malignant tumors is surgical and requires extensive removal along with the surrounding intact tissue.  In some tumors, it may be attempted to shrink the tumor by using chemotherapeutic agents before surgery.

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