Eyelid problems are common but rarely serious. Eyelids can sometimes develop cysts or get inflamed or infected. Changes in the position of the eyelids, such as droopiness, often happen gradually with age.
These problems are usually nothing to worry about. However, if your eyes have become watery or uncomfortable because of an eyelid problem, or if you're worried, you should see your GP. If you also have pain or loss of vision, see your GP urgently.
In the meantime, the information below should give you an idea of what might be wrong, although this should not be used to self-diagnose your condition. It covers the possible causes for the following eyelid problems, and specific advice on what you should do:
Swollen eyelid or eyelid cyst
It is quite common for the upper or lower lid to become swollen because of the formation of a meibomian cyst (also called a chalazion).
Meibomian cysts vary in size, from just visible to the size of a grape. They usually take weeks to develop. They are not particularly painful, but if they get infected they will increasingly become red and painful.
Usually, these cysts come and go by themselves. You can increase the chance of the cyst healing by holding a clean flannel warmed in hot water to the closed eye for five minutes. Repeat this three to four times a day for two weeks.
If the cyst is large and does not go away after a couple of months, see your GP, who can refer you to have it surgically drained. This simple procedure is done under local anaesthetic (which numbs the eye area), takes just five minutes and leaves no scar.
If the cyst gets infected, see your GP as you may need to take antibiotics to prevent a deep lid infection (cellulitis).
Meibomian cysts are not the same as styes. Styes are minor infections of the base of an eyelash and nearly always go away by themselves. In rare cases, styes can cause a lid infection (the lid will be red, hot and painful), in which case you would need antibiotics.
Meibomian cysts and styes are not caused by poor personal hygiene. They are, however, related to having blepharitis, which is inflammation of the edge of the lid, causing oily tears (see gritty, itchy or flaky eyelids below).
Other causes of lid swelling are rare. These include an allergic reaction, shingles on the face and eye (usually with a rash) and other rare eye problems, which would cause other symptoms such as loss of vision.
Gritty, itchy or flaky eyelids
Gritty or burning eyes are usually caused by an inflamed lid edge (blepharitis) or dry eye. Symptoms are typically worse in the morning or at the end of the day.
People with blepharitis also have a higher risk of getting meibomian cysts, also called chalazia, in their lid (see above).
Gritty, itchy or flaky lids are irritating, but rarely serious. It is possible to reduce this irritation by keeping the lid clean and using artificial tears. Read about treatment for blepharitis.
Another possible cause of itchy or flaky lids is contact dermatitis. This is a type of eczema that is triggered when the skin comes into contact with something you are irritated by or allergic to. For example, your eyelids may be sore and itchy because you are allergic to the eye shadow you've been using or because you've been touching your eyes with fingers painted with nail polish. The condition usually clears when you stop using the substance your skin is reacting to.
Lumps on the eyelid
Just like anywhere else on the skin, lumps can occur on the eyelids. Many lumps are simple cysts (see above).
However, if the lump increases in size, changes colour, has an irregular shape or bleeds, see your GP as this lump could be skin cancer.
If the lump looks like skin cancer, it is often necessary to remove it with surgery. Most skin cancers are basal cell carcinomas and do not spread to other parts of the body, although they continue to grow on the lid.
Less commonly, the tumour may be a squamous cell carcinoma, which rarely spreads to other parts of the body.
If the mass is dark in colour, it could be a melanoma, although this is relatively rare. A melanoma will need early treatment as it can spread to other parts of the body and can be dangerous.
Droopy upper eyelid
As you get older, it is quite common to have excess skin above the upper lid. This can overhang and block vision, and is called dermatochalasis. If it affects vision, surgery could be considered to remove the excess skin (blepharoplasty).
If the edge of the upper lid droops down, reducing eye opening, it is called ptosis. Ptosis is typically age related and occurs slowly. Surgery is available if the edge of the lid falls so much that vision is affected.
In rare cases, ptosis is not related to age and may be caused by other conditions. In this case, there would be other symptoms too. If the ptosis comes on rapidly, over days or weeks, or is associated with other symptoms, such as headache or loss of vision, see your GP immediately.
Rolling outwards of the lower eyelid (ectropion)
The lower eyelid can sometimes droop away from the eye and turn outwards. This is known as an ectropion.
Ectropion can affect just one or both of the lower lids. It is usually related to ageing, but can also be associated with sun-damaged facial skin.
If it is mild, no treatment is needed. If it causes your eye to be watery or uncomfortable, surgery can be considered.
Read more about the treatment of ectropion.
Rolling inwards of the eyelids (entropion)
If the eyelid rolls inwards, it is known as entropion. It usually affects the lower lids, but can also affect the upper lids.
Entropion usually causes an uncomfortable watery eye, because the lashes irritate the front of the eye (cornea). If this is mild, using eye drops may be enough to protect the eye and keep you comfortable.
If entropion is severe, it can be painful and cause loss of vision by damaging the cornea. A corneal ulcer can form and become infected. Surgery may be needed to correct the entropion if it is causing a risk to the health of the eye. This is done under local anaesthetic and usually takes less than an hour.
If you have entropion, see your GP to discuss treatment. If your eye becomes painful, red and you lose vision, see your GP urgently.
Yellow plaques on the eyelids
The appearance of flat yellow patches (plaques) over the upper or lower eyelids is called xanthelasma.
These plaques are entirely harmless, but they suggest that your cholesterol level could be high. See your GP to assess your risk factors for future blood vessel problems, such as heart attacks and strokes.
It's important to have treatment if you have high cholesterol, high blood sugar (diabetes) and high blood pressure, and to stop smoking to reduce your risk of future blood vessel problems.
Excessive blinking or uncontrollable closure of the eyelids
It is quite common and normal for the eyelid to flicker or twitch occasionally, especially when you are tired.
It is much more unusual to have repeated spasms of excessive blinking and involuntary closure of the eyes. This is known as blepharospasm. Each spasm can last for a few seconds to a few minutes.
It's not known exactly what causes blepharospasm. However, the blinking and closure may be triggered by bright light, stress or tiredness.
If severe, this problem can be very disabling and embarrassing. However, there is an effective treatment. Small injections of botulinum toxin (Botox) into the facial skin can provide relief for this distressing problem. See your GP to discuss this
Read the US National Eye Institute's fact sheet on blepharospasm.