Ophthalmology

Inflammation of the lower eyelid

General

We all know it: a thick and swollen eyelid. Sometimes it itches, flakes, is somehow weeping. Sometimes an eyelid can even swell so much that the affected eye can no longer be opened properly. And of course someone else notices it immediately, because it sits in the middle of the face and can therefore be quite disfiguring. The causes of such a swollen eyelid are extremely diverse. Fortunately, most of them are harmless and the eye itself is usually not directly affected and therefore out of danger. In cases of doubt, an inflammation of the lower eyelid should nevertheless be clarified by a specialist doctor, such as a dermatologist or an ophthalmologist.

Read more on the topic: Eyelid inflammation

diagnosis

In the case of a swollen lower eyelid, the main question is whether it is a inflammatory Is done or about one non-inflammatory process. Furthermore, the following questions can facilitate the exact diagnosis:

Is only one of the eyes affected or are both eyes swollen?
Where is the exact location of the swelling? (Upper / lower eyelid, inside on the lid / outside / only on the edge of the lid)
Is the inflammation confined to a small area (localized) or is the entire eyelid affected?
How long has it existed? (acute / chronic)
Are there any other noticeable changes on the surface of the skin? (Redness etc.)
Overall, does it feel soft or hard and rough?

Symptoms

The hailstone is a chronically clogged meibomian gland in the lower eyelid.

Depending on what is the reason for the swelling of the eyelid, it can also be that the closely adjacent parts of the eye itself are also affected, e.g. the cornea or the conjunctiva. The affected eye can itch and burn, suffer from dryness or even impaired vision.

There is also swelling in the area of the eyes and eyelids that has been present since birth, for example a small blood sponge (in technical language as capillary hemangioma called), or a colloquial mole (which does not necessarily have to have the typical brown color, but can be slightly raised, i.e. protruding like a pimple), which is also called Nevus cell nevus referred to as. Fortunately, all of the illnesses mentioned above are usually harmless and are more of cosmetic than medical relevance. Swollen eyelids also play a not insignificant role in cosmetic surgery / plastic surgery. Often the drooping lower eyelids, popularly known as "drooping eyelids" or "bags under the eyes", are perceived as annoying and unaesthetic and those affected want them to be removed. However, this is an exclusively beauty cosmetic topic and is of no medical interest.

However, where caution is needed is the eyelid swelling, which is caused by severe inflammation of the eye or the orbit. One should also pay attention if not only the eyelids swell, but also swellings or changes of any kind in other parts of the body. This could, for example, be due to an acute shock, a so-called Angioedema or point out the "hives". If swollen eyelids appear in pregnant women, this could be the first sign of preeclampsia (a pregnancy-related disease called a Gestosis). In rare cases there is also a tumorous process behind the swelling. Fortunately, the most common is hailstone, a typical and widespread form of chronic eyelid inflammation.

This article might also interest you: The itchy eyelid.

Causes of swollen eyelids

So how is it that our eyelids can swell? This is due to the anatomical structure of the eyelids. The skin on the lids is very thin and the tissue underneath is relatively loose and soft. There are few fat cells in it, but all the more blood vessels and lymph vessels. It follows from this that a lot of fluid is moved here in a very limited area. The lids are also limited by the so-called tarsus, a connective tissue base plate that forms the basis for the lids and that is firmly fused with the eye socket in the corner of the eye. On the one hand it acts as a solid "foundation stone" for the lid, on the other hand it also limits it and functions like a barrier. If the fluid level in the entire body rises even a little, this can be seen very quickly in the eyelids, since this is where edema forms first, i.e. fluid accumulations in the tissue where not so much fluid actually belongs. Due to the anatomy, this fluid can most likely flow off across the root of the nose to the other side and into the other eyelid, which is why one eyelid seldom swells on its own, but both are usually affected.

It's all natural and nothing to worry about if you can In the morning wakes up with somewhat thick and puffy eyelids. Laying the body fluids are distributed a little differently than when standing and so it can sometimes become one slight edema formation come in the eyelid area. But when you get up and take the first few steps, the circulation in the body gets going again and the edema recedes very quickly.

For some women, menstruation can lead to swollen lids, but that is the case hormonal conditionally.However, if the swelling does not go away after a while or if there are additional symptoms, be it in the immediate area of the eyes or in other parts of the body, caution is required and a doctor's visit is advisable.

It can also be that the swelling of the eyelids is caused by a Internal organs disease, for example the liver or kidneys. If this is suspected, the Family doctor visited who will then issue a referral to the appropriate internist. Significant symptoms would be tiredness and exhaustion, poor concentration and clouding of consciousness.

Resets the eyelid swelling very suddenly and is accompanied by breathlessness and severe abdominal pain, this is definitely a case for him Emergency doctor. Is an existing one in a patient Angioedema known, emergency medication is usually available.

For more information, see: Eyelid swelling

Inflammatory diseases as the cause

Now we come to the numerous inflammatory diseases that can cause a swollen lower eyelid. Here it is important to keep in mind that inflammatory skin diseases can also spread to the area of the eyes and become one there Inflammation of the lower eyelid can lead (to a Blepharitis).

Viruses

But not just bacteria, too Viruses can lead to problems and inflamed lower eyelids. Here would be the Herpes simplex, of the Herpes zoster, Dellar warts (Mollusca contagiosa) and the Hailstone the most common clinical pictures.

bacteria

Inflammatory swelling of the lower eyelid can be caused not only by skin diseases, but also by Pathogens. Contact lens wearers are particularly often affected by inflammation in this area due to frequent contact with the eyes and eyelids and must therefore be particularly careful and thorough when it comes to eye hygiene.

bacteria can for example become a Erysipelas, one Lid abscess or one Eyelid phlegmon as well as to one Stye to lead. The latter is probably the most widespread inflammation of the lower eyelid. This is actually an acute and bacterial inflammation of one (or more) of the Meibomian glands in the lower eyelid. Mostly are Staphylococci the pathogen. A stye can appear on both the lower and upper eyelids. In addition to inflammation of the lower eyelid, there is also very painful swelling and reddening of the skin that can spread to the entire eyelid. A stye is not dangerous in itself, it is primarily painful and the swelling hinders vision. However, if barley grains accumulate, you should have your family doctor check your blood sugar levels to help you Diabetes mellitus to exclude.

Eczema on the eyelid

Eczema is one of the most common skin diseases worldwide. They come in many different forms and they are not infectious. The eczema also includes allergic contact dermatitis, neurodermatitis (sometimes also as Atopic dermatitis or atopic eczema and seborrheic dermatitis. The skin disease rosacea can also promote lower eyelid inflammation.

Read more on this topic at: Contact dermatitis

Acute eczema on the eyelid can be recognized by the typical symptoms: severe itching and reddened skin, small blisters or nodules, swelling and crust formation on the affected area. Over time, the skin thickens there and becomes very dry and tears.
Such eczema is very uncomfortable and annoying, especially in the area of the lower eyelids.

In order not to overlook another more serious illness, one should always clarify the cause of the eczema on the lower eyelid. They are not dangerous per se, but the torn and inflamed skin surface can create a favorable environment for parasites such as mites and lice, which is why careful eyelid care is so important.
If the cause of the inflamed lower eyelid is really “only” a skin disease, it is better to see a dermatologist instead of an ophthalmologist.
But be careful: both the stye and the hailstone should both always be examined by an ophthalmologist.

Read more on the topic: Eczema on the eyelid

Stye

There are also several glands in the lids. The so-called Meibomian glands for example produce tallowthat keeps the edge of the eyelids and eyelashes supple. From the edge of the eyelid, the greasy secretion is also transported to the inside of the eyelid, thus reducing friction between the eyelid and the surface of the eye. There are also those Zeis glands and the Minor glandswho also each tallow and Sweat and open between the roots of the eyelashes on the edge of the eyelid.
Clogged such a small gland and / or ignited itself, the secretion produced in it and the Gland swells and with it the lid in place. The clinical picture is then also known as "Stye“.

Inflammation of the lower part from a hailstone

The so-called Hailstone it is also a Inflammation of the lower eyelid, but of a different kind. Here the cause of the inflammation lies in one thing chronically clogged meibomian gland in the lower eyelid.
The sebum-like secretion builds up more and more and the tissue around it becomes inflamed. A small hard nodule forms at the site of the gland. However, there are usually no bacteria or viruses involved, it is just one nodular clusters of cells in the tissuethat has formed due to the chronic inflammation (in this case, doctors also speak of a so-called granulomatous disease).
The hailstone is also, unlike a stye, no longer painful and at most disturbing due to its size and location. Sometimes it is also slightly reddened, but that is not a problem. The hailstones usually recede on their own after a while, only in particularly stubborn cases does the doctor need to help with medication and prescribe anti-inflammatory ointments or tablets.