Lids and Lashes


Blepharitis is an inflammation of the eyelid including lid margin and eye lashes, due to poor lid hygiene, clogged oil glands of the eye lid, mild eye lid infections and acne rosacea.  Signs and symptoms are crusty eye lid debris, red and swollen eyelids, mild pain, burning, tearing, and foreign body sensation, itchy eye, shutting of the eyelids upon awakening with or without mucous discharge.  There are two types of blepharitis; anterior and posterior.  

Anterior blepharitis is caused by mild bacterial infection of the lid margins.   It is usually treated by medicated lid scrubs to clean the eyelids, antibiotic/steroid combination drops or ointment, apply to lid margin to treat the underlying inflammation and infection.

Posterior blepharitis is caused by clogging of the oil glands along the posterior margin of the eye lids, which subsequently can lead to dry eye and styles of the eyelids.  It is usually treated by warm compresses and lid message of the eye lids to clear out the oil glands.  Occasionally for advanced cases, oral antibiotic/inflammatory medication may be needed for chronic usage.

Artificial tears drops or ointment may be needed to lubricate the eye in both blepharitis conditions. 

How to use lid scrubs,

  1. a)Tear open the medicated cloth from the pouch, close both eye and gently scrub the edge of both eye lids.
  2. b)Wash your eye lids gently with warm water and dry them with clean cloth before opening the eyes.

How to message and warm compresses of the eye lids,

  1. a)Soak the paper tower with hot water, close both eyes and press gently along the edge of the eye lids.
  2. b)While the eye is still closed, perform gentle lid messages on top and bottom eye lids, using two of your fingers.
  3. c)Then open your eyes.

Hordeolum (style)/Chalazion

When the lid is suddenly swollen and red with pain upon palpation, either on the upper lid margin or lower lid margin, it is usually a style of the lid.  It is caused by a bacterial infection of oil glands of the lid margin (meibomian glands).  When the pain is involved and tender to touch, it is called hordeolum.  When the pain is not involved and hard to touch, it is called chalazion.  Either hordeolum or chalazion, the standard of care is warm compresses and lid massages for chronic care, because it is recurrent.   Oral antibiotics and topical antibiotic/steroid ointment may be needed in cases of hordeolum, to prevent the spread of the disease across the eye lids.   Chalazion is a residual aggregation of inflammatory cells following eye lid infection such as hordeolum.  It is non-infectious and twenty five percent of chalazion resolved spontaneously.  Treatment is the warm compresses and lid massages, around the nodule 2 to 4 times a day.  If ineffective, steroid injection into the chalazion and surgical excision is needed to as a last step.

Preseptal Cellulitis

In preseptal cellulitis, patients are usually present with an acutely painful and swollen eye lid, similar to the hordeolum (style).    In some cases, the swelling of the lid is so severe that the patient may not be able to open their eyes.  However, the vision isn’t affected.  The common causes are recent sinus infection, dental infection, hordeolum and trauma.    The standard treatment is oral antibiotics for 7 days.   Children are still needed to take oral antibiotics but must consult with their pediatrician for correct dosage.  We may refer the children patient to their pediatrician to continue the treatment.  If the children are not better or getting worst during antibiotics therapy, they may need to be admitted to the hospital for CT scan and IV antibiotics. 

Orbital Cellulitis

                Orbital cellulitis is a microbial infection and inflammation of the tissue within the orbit.  When the swelling of the lid involve the interior part of the orbit, with proptosis, significant pain upon palpation, decreased in vision, and eye muscle restriction.  Patients can be young or old, and they usually have fever.   The cause of the infection is usually from penetrating lid injury, bite wounds, sinus infection or dental infection.  This situation is usually a medical emergency, and requires hospitalization with IV antibiotics.

Therefore, when a patient is presented to our office for pain and swelling of the lid, we have to differentiate between hordeolum, blepharitis, preceptal cellulitis and orbital cellulitis.  We may put you on topical drops and ointments, oral antibiotics or refer to the specialist for further care such as hospitalization and IV treatment.


                It is an acute or chronic infection or inflammation of the lacrimal sac, associated with the pain, tenderness, and swelling of the tissue around the nasal part of the lower lid with associated tearing.  It is common in older population, and result from mucous obstruction, blockage and bacterial infection of the lacrimal duct.  It is also seen in infants with same presentations.  Treatment includes oral antibiotics with topical antibiotic drops, ointments, and warm compresses.  In some cases, dilation and irrigation of the lacrimal ducts procedure is performed to clean out the lacrimal ducts from mucous blockage.  In infants, hospitalization is usually required for surgical approach.


                Xanthelasma is benign, yellow in color, deposits of fatty materials on the skin.  About half of patients with these lesions are related to high lipid levels (high cholestrol).  These skin deposits are common in patients over 40 years of age.  Women are affected nearly twice as often as men.  Treatment is only available surgically and that is due to cosmetic reasons.  All the patient has to do is to get a blood work for cholesterol and get treated by their primary care physician if they haven’t done so.  


                Dermatochalasis is a sagging of the eyelid tissue, encountered more commonly in older individuals.  Skin tissue losses its elasticity overtime, droops in front of the eye, and sometimes block the vision.  This is a benign condition and only surgical treatment is available, known as blepharoplasty. 

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