What do the eyelids and lacrimal system do?

The eyelids close quickly to protect the eye from danger, and during sleep. They contain glands which contribute to the tear film. The “wind shield wiper-like” blinking action of the lids cleans the surface of the eye, keeps its surface moist and removes ‘used tears’. The lacrimal system comprises the tear secreting glands and the pathways for tear drainage from the eye – the eye’s ‘plumbing system’.

What can go wrong with the lids?

Abnormal eyelashes turn towards the eye and cause irritation and eye damage – trichiasis. The oil secreting glands of the lids may become inflamed – meibomitis, or the eyelashes may get infected – blepharitis. Often both occur together as lid margin disease. If the glands get infected, pain and swelling may result – stye and chalazion. The position of the lids may be altered due to ageing, injury or other causes – they can turn towards the eye, entropion; or droop away from the eye, ectropion. Sometimes, the lids fail to close completely – lagophthalmos, or open fully, ptosis. Rarely, involuntary movements of the eyelids can occur – occasionally or as a more constant phenomenon – blepharospasm.

What can go wrong with the lacrimal system?

A common problem is a ‘block’ in the plumbing system, resulting in tear overflow from the eyes – epiphora. Sometimes, the opposite can happen and less tears are produced – dry eyes. The tear passages can get infected – canaliculitis, dacryocystitis, or the lacrimal gland can get inflammed – dacryoadenitis.

How will I know if I have eyelid and lacrimal system problems?

Eyes may feel dry and uncomfortable if tear production is reduced. Constant watering is a sign of blocked tear drainage. Malpositioned lids cause pain and irritation. Inability to open the lids can affect vision, especially in children. Infections of the lids and drainage channels can produce swelling, redness, and pain in and around the lids.

What are the common causes of these problems?

Ageing can affect the structure and functions of the lids, tear glands and drainage passages. Some problems are present from birth while others result from weakness of the nerves or muscles in and around the eyelids. Infections and metabolic changes in the glands are also important causes.

How can these problems be treated?

Infections require prompt treatment, especially in children, since spread beyond the eye can occur easily resulting in serious consequences. An advanced chalazion needs minor surgery.

Altered eyelid position and inability to open or close them properly often need to be corrected by surgery. Early treatment prevents damage to the eyes and aids visual development in children.

Blocks in the drainage passages need thorough evaluation to decide the site and type of blockage. Once recognized, they may need corrective surgery.

Swellings in the lacrimal gland often herald serious problems – infections, inflammations, and tumors are possible and need appropriate management.
A dry eye can be treated using a variety of approaches – eye drops and oral medicines, blocking tear drainage, and other surgical therapies. Relief can be provided in almost all patients with this condition.

What are the recent advances in the management of these conditions?

A chalazion can be treated with injections instead of surgery. Botulinum injections offer a quick and painless solution to troublesome muscle spasms. Blockage of drainage passages can be cleared using endoscopic methods without scars on the face. A wide range of eye drops is available for patients with dry eyes.