Anatomy-Lexicon

eyelid

definition

The eyelid is a thin, muscular fold of skin that forms the front border of the eye socket. It covers the eyeball immediately below, from above through the upper eyelid, and from below through the lower eyelid.

The eyelid fissure is located between the two lids, and the upper and lower eyelids meet at the side (towards the nose and temple) and form the corner of the eyelid. In addition to muscle tissue, glandular and connective tissue can also be found in the eyelid.

Function of the eyelid

The main function of the eyelid is to protect the underlying eye, as well as to keep it moisturized and clean. Occasional involuntary blinking causes tear fluid to flow through the eyelid over the eyeball to moisten it.

The eyelid also offers protection against mechanical influences such as insects or contact. The blink of an eye (better known as blinking) is performed within 300 ms, i.e. just under a third of a second. This quick reaction is necessary because the eye is on the one hand very sensitive, on the other hand it is limited to the rear only by bony structures - so there is nowhere to go.

The eyelid absorbs and distributes some of the energy that arises from blunt impacts (for example a blow to the eye).

It is controversial why we close our eyelids when we sneeze. On the one hand, one suspects the body wants to counteract the excessive pressure that arises when sneezing in order to protect the eyes. On the other hand, it could also be a protective reaction of the body, through which the re-entry of coughed up bacteria and viruses into the mucous membrane of the eyes is to be prevented.

Glands of the eyelid

In the immediate vicinity of the eyelids there are a number of glands, including the Zeis, Moll, and Meibomian glands. In different compositions, they produce a fluid similar to sebum or sweat, which protects the eyes from drying out. They often cause inflammation - their most famous representative is probably the stye.

It is important not to express the pus contained in the stye, as it could otherwise get into the brain via the venous system. Incidentally, this generally applies to purulent processes in the so-called T-zone on the face.

The therapy of choice is a disinfectant and / or antibiotic treatment.

Disorders of the eyelid

Disorders of the eyelid are common and can affect several areas:

A movement disorder of the eyelids in the form of drooping of the upper eyelid is called "ptosis" in medicine. Mostly there is a disruption of the nerve pathway that serves the eyelid elevator muscle.

Another movement disorder is constant unwanted and uncomfortable twitching of the eyelid. Even if this phenomenon is usually perceived as very annoying, in the majority of cases it is harmless and usually disappears on its own after hours to days. Causes can be stress, irritation of the eyes from foreign bodies, alcohol consumption, sleep deprivation, or mineral (magnesium) deficiency.

A delayed eyelid closing reflex is known as the Stellwag sign and usually occurs in the course of an overactive thyroid gland (Graves' disease).

In addition to movement disorders, there are also inflammatory and parasitic diseases that can affect the eyelid. These include abscesses, cysts and tumors, such as basaliomas and melanomas (both originating from the skin) or hemangiomas (originating from the blood vessels in the eyelid).

In the hereditary disease Down's disease (also Down syndrome, trisomy 21), a crease in the eyelid that covers the eye is characteristic. Since it is physiological in Asia - i.e. without any disease value, it is often referred to as a Mongolian fold.

Twitching of the eyelid

An eyelid twitch usually has a harmless cause.

Possible causes can be stress, inner restlessness or tension, tiredness or eye strain, for example from working long hours on the computer. A lack of magnesium can also be the cause of muscle twitching. Furthermore, a foreign body in the eye, an inflammation of the eyelid or conjunctivitis can trigger the twitching. Serious infections, neurological diseases, multiple sclerosis or tumors are less likely to cause eyelid twitching.

The twitching is caused by irritation of the facial nerve, which causes the muscles of the eyelid - the orbicularis oculi and the levator palpebrae superiores muscles - to contract and relax in an uncontrolled manner. As a therapeutic measure, you can first gently massage the eyelid with your fingers. Carefully rubbing the closed lid with a warm washcloth can also help the muscles relax again. Another option is the use of gel-filled glasses that you can get in pharmacies or drugstores. This can be placed on the closed eyes, warmed up, because the warmth allows the muscles to relax.

Usually the twitching stops by itself. However, if the twitching lasts longer than a week or occurs more than once a month, you should consult an ophthalmologist. If the twitching occurs together with symptoms such as loss of sensitivity and / or muscle paralysis in the face, as well as slurred speech or visual disturbances, an emergency doctor should be called as a heart attack or stroke is suspected.

Inflammation of the eyelid

Inflammation of the eyelid margin is also known as blepharitis.

The most common symptoms can be itchy, reddened, thickened, flaky eyelids, a foreign body sensation, accompanying conjunctivitis or eyelash loss (madarosis) with the growth of eyelash-like hair from the meibomian glands (distichiasis).

A common cause of the inflammation of the eyelid are external factors such as smoke, dust or a dry room climate, but also endogenous factors such as hypersecretion of the eyelid gland, accumulation of secretion from the meibomian glands or increased sebum production (seborrhea). Dandruff often forms on the eyelid. Since the inflammation creates favorable conditions for pathogens, a superinfection with mainly staphylococci can occur.

The first therapeutic measure should be the eyelid margin care, in which the encrustation is soaked with warm water or lotions and then carefully removed with a cotton swab. You can also try to gently squeeze the glands. If the inflammation does not improve within a few days, you may have to switch to antibiotic eye drops or systemic antibiotics. An allergic reaction or dry eye can also cause the picture of eyelid inflammation.

Eyelid eczema

Eczema is an inflammatory change in the skin that, in addition to reddening, often occurs with symptoms such as burning or itching.

The causes of eyelid eczema are diverse. Often times, rubbing the eyes with your fingers rubs molecules or particles into the eye that can make eczema worse. Possible causes are substances that can trigger an allergic reaction in the eyelid. These include cosmetics and skin care products, mascara, hair care products that can get into the eye, but also contact lenses and the care products for contact lenses.

Fragrances in detergents, environmental allergens such as pollen, house dust mites or food, or substances in jewelry such as nickel can also cause eyelid eczema.

Eczema can also be a symptom of atopic dermatitis, also known as neurodermatitis. As a first therapy one should avoid suspicious substances and consult a doctor if the symptoms occur more frequently.

Warts on the eyelid

Warts on the eyelid are usually harmless and do not need to be removed from a medical point of view.

Nevertheless, one should see a doctor if one notices a growth, as it is difficult for a layperson to distinguish the good growths from the malignant ones. Often the warts are pedunculate warts, as they can also be found on other parts of the body such as armpits or groin. The warts arise from the growth of fibrocytes and are therefore also called firboma.

Surgical removal should only be justified, if at all, for aesthetic reasons and does not guarantee that the warts will not come back.

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Removal of warts
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Symptoms on the eyelid

Swollen eyelid

Swelling on the eyelid can have various causes and in most cases it is harmless.

Since the eyelid is anatomically predestined for swelling due to weak connective tissue and few muscle fibers, it can often swell as an accompanying symptom. A common example is the allergic reaction to pollen - the nose begins to itch, the eyes become red and can itch as well, and the eyelids swell. These symptoms will go away as soon as you do something about the allergy.

If it is another example of a child who has a cold, one speaks colloquially of a "red eye". The tear fluid, triggered by a build-up of secretion and swelling in the nose and paranasal sinuses, can no longer flow out of the eye through the tear duct, so that the fluid collects in the lids. If you keep the child's nose free with decongestant nasal drops or spray, the eyelids will also swell after a while.

Other causes can be an allergic reaction to an insect bite, atopic diseases (atopic dermatitis, bronchial asthma, allergic rhinitis), inflammatory skin diseases (eczema), inflammation of the eyelid margin (blepharitis) or the conjunctiva (conjunctivitis) or the hormonal status of the Being a woman, although before menstruation the eyelids can swell.

More rarely, abscesses or tumors can be responsible for the swelling.

As a measure, you can try to swell the eyelid with the help of cold black tea bags or cool packs. If the swelling lasts for an unusually long time, if it increases, or if pus develops, you should see a doctor.

Eyelid pain

Eyelid pain can have a variety of causes.

If it is an inflammation, the following symptoms may appear as signs of inflammation: Calor (overheating), Rubor (reddening), Dolor (pain), Tumor (swelling) and Functio laesa (impaired function). One possible cause is a stye or hordeolum, which is an acute bacterial inflammation of an eyelid gland.

A typical pathogen in stye is the bacterium Staphylococcus aureus, more rarely streptococci. A hordeolum internum, in which a meibomian gland (sebum gland on the edge of the eyelid) is inflamed, and a hordeolum externum, in which a minor or sebum gland is inflamed.

A stye manifests itself as a painful red point or lump in or on the eyelid with a possible central pus point that can spontaneously open and flow out. A stye is treated with local antibiotics, heat and infrared radiation, among other things.

Blepharitis, the inflammation of the edge of the eyelid, can also be painful. Another cause can be wearing contact lenses that rub against the inside of the eyelid.

Reddened eyelids

When the eyelid is reddened, the upper eyelid is usually affected.

One cause can be inflammation that makes the eyelid blush. The reason for this can be an inflammation of the eyelid or a grain of barley or hail. Other accompanying symptoms in these cases are adhesions and itching, swelling and a foreign body sensation on or in the eye.

An allergy to pollen, food or medication, for example, can also cause reddening. Accompanying the reddening, the eye can water. Another cause can be contact dermatitis, triggered by contact lens products, care products or cosmetics, for example. In addition to reddening, the eyelid may also be swollen and itchy in this case.

Depending on the cause, it may be advisable to rinse the eyes and treat them with cold or heat, as is advisable for stye.

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Hailstone

Itchy eyelids

Itchy eyelid is often an accompanying symptom of an inflamed or irritated eyelid.

Often times, a dry or overworked eye is to blame for itching. In this case, it helps to close and open the eye several times to create a tear film as a lubricant or just to close the eyes to relax. Special eye drops for dry eyes can also help against the itching.

Another cause can be allergies that make the eye itchy. In this case, it is advisable not to rub the eye, as this could cause more allergens to get into the eye and increase itching. Cosmetics can also irritate the eyelid and cause itching. Another possible cause is inflammation of the eyelid or conjunctivitis. In this case, too, rubbing should be avoided.

A remedy for itching are cool, wet towels or cotton pads that you can put on your eyelids.

Drooping eyelids

A drooping eyelid is also known as ptosis and describes a low position of the upper eyelid.

Hanging often leads to impaired vision. Muscle weakness, impairment of nerves or weak connective tissue can be considered as the cause. Drooping of the eyelid can exist from birth. In this case, it is a congenital disorder in which the eyelid elevator muscle or the nerve responsible for it have not been properly developed. A drooping eyelid can also occur with advancing age. The reason for this is the connective tissue in the eyelid, which loses its elasticity with age and thus becomes slacker.

Furthermore, a drooping eyelid, among other symptoms, can be part of a chronic disease, as is the case with myasthenia gravis.

If the drooping of one or both eyelids occurs suddenly, a doctor should be consulted immediately, as it could be a stroke or a cerebral haemorrhage. More rarely, poisoning, for example by snake venom or the botulinum toxin of the bacterium Clostridium botulinum, can be the reason for a drooping eyelid.

Lump on the eyelid

A lump on the eyelid is usually nothing to worry about.

Often the lump is a hail or stye caused by a blockage of drainage from the Zeis, Moll, or Meibomian glands. A hailstone usually appears as a nodular swelling on the edge of the eyelid, originates from the Zeis or Meibomian glands, is not tender to pressure and is not contagious. A stye, on the other hand, is contagious when it is infected with bacteria such as streptococci or staphylococci, can affect all three glands and can be painful. Both types of inflammation are accompanied by redness and swelling.

If the lump has a yellowish color and is sharply demarcated, it can also be a xanthelasma, a deposit of fat or cholesterol. Less often there is a malignant degeneration behind a lump. The most common malignant growth on the eyelid is basalioma. Much rarer are eyelid tumors that originate from the squamous epithelium, sebum glands, or from Merkel cells in the skin, as well as melanoma. If you notice a growth on the eyelid, you should definitely consult a doctor for clarification.

You might also be interested in these topics:

Clogged tear duct
Basalioma of the eye
Causes of Xanthelasma

Dandruff on the eyelid

In general, small white or grayish flakes are a sign of dry skin, where the sebum glands are not producing enough sebum. But overproduction of sebum can also lead to dandruff, which then looks more yellowish and greasy.

Dandruff on the eyelid can be a symptom of blepharitis. The inflammation starts from the sebum glands on the edge of the eyelid, which clog. White-gray greasy scales form on the edge of the eyelid, so that the disease is also called blepharitis squamosa.

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Procedures and operations on the eyelid

Most eyelid surgery is cosmetic.

For example, wrinkles in the eyelid (so-called eyelid folds) can be treated by plastic surgery with the help of botulinum toxin, better known as "botox". Botox is the strongest known neurotoxin to date, it paralyzes the transmission of signals from nerve cells to muscles. In everyday life, we come into contact with this poison in the case of food poisoning after consuming expired canned food.

Medicine makes use of the fact that the eyelid relaxes without contracting muscles and does not wrinkle. However, the effect usually only lasts for 2-6 months, after which the treatment must be repeated.

In addition to eyelid tightening, eyelid lengthening and tumor removal, the correction of ptosis (lowering of the eyelid) is also a common operation. This involves performing an operation on the upper eyelid lifting muscle with the aim of lifting the upper eyelid.

Eyelid lift

An eyelid lift is a cosmetic procedure and is used for the surgical correction of age-related wrinkles and sagging eyelids, the drooping eyelids.

Since the eyelids only consist of a thin layer of skin, fat tissue and muscle strands, environmental influences such as direct sunlight or an unhealthy lifestyle can quickly droop the eyelids. The eyelid tightening usually takes 1-2 hours, takes place on an outpatient basis and is usually carried out under local anesthesia or in twilight sleep. A distinction can be made between different procedures in which skin folds, fatty tissue and / or muscle fibers are removed for a younger look.

With the upper eyelid lift, the overhanging skin is measured before the procedure and the incision is made in the natural crease of the eyelid so that the scar cannot be seen when the eyes are open. A lacrimal sac surgery can be performed on the inside or outside of the lower eyelid. In the case of an external operation, the incision is made on the edge of the eyelid, so that the lower eyelid is pulled up to the incision edge after the tissue has been removed, thus tightening the lower eyelid.

After the operation, it is important to take care of the scars and to rest for about 6 weeks. After 4-6 days, the sutures can be removed. Since the eyelid lift is primarily a cosmetic procedure, the costs must be borne by yourself.

Further information on this:

Eyelid lift
Drooping eyelids - home remedies that help

What is an eyelid correction?

An eyelid correction or blepharoplasty is the plastic surgery of the eyelids. It is one of the most frequently performed aesthetic procedures, tightens the eyelid and is said to give you a youthful appearance.

The correction can be performed on an outpatient basis using a local anesthetic. You can choose between the correction of the upper eyelid, the lower eyelid or the tear sac. The excess skin is removed and, if necessary, some tissue is also removed in order to tighten the eyelid.

Since an eyelid correction is a cosmetic procedure, the costs for such an procedure must be borne by yourself. In rare cases, however, there may also be a medical indication, so that you should contact your health insurance company about possible reimbursement of costs.

Tapes for the eyelid

Tapes for the eyelid are plasters that are supposed to help "stick away" drooping eyelids.

They are also called drooping eyelid tapes or eyelid correction patches. A drooping eyelid is a drooping upper eyelid, which can reach up to the upper front edge of the eyelashes. A drooping eyelid is a natural phenomenon of aging, as the connective tissue weakens with age and the skin slackens, so that wrinkles appear. Using tapes or plasters that are stuck into the crease of the eyelid, the crease is artificially raised and the excess skin is "glued away". The tapes are therefore an alternative to the cosmetic surgical removal of drooping eyelids.

You can find the eyelid tapes in drugstores or at various Internet providers.