What are the symptoms of eyelid inflammation?

Sick, inflamed eyelids are thickly swollen and reddened. As a rule, those affected wake up in the morning with glued eyes and on the edge of the eyelids, between the lashes and in the corners of the eyes there are yellowish, slightly greasy scales and crusts. In addition, the eyes usually burn and itch severely and tend to produce more tears (also due to the constant foreign body sensation in the eye).

Those affected are more sensitive to light and the blinking alone can be very painful. As a further consequence of an infection of the already inflamed eyelids, ulcers can form, the eyelashes are damaged and can fall out or turn to the inside of the eyelid and thus additionally rub against the conjunctiva and cornea. If the inflammation of the eyelid, the blepharitis, is not caused by any skin diseases but by pathogens, the following possible clinical pictures should be considered: Erysipelas, eyelid abscess, eyelid phlegmon, phlegmon of the orbit, a barleycorn, a herpes simplex outbreak, herpes zoster that manifests itself in the facial area, molluscic warts (also called mollusca contagiosa), a hailstone, an inflammation of the lacrimal gland, the lacrimal sac or a closure of the lacrimal duct.

Causes of inflammation of the eyelid

First, a brief overview of the possible causes of inflammatory swelling of the eyelid is given here. If the eyelid is due to an existing or newly appeared skin disease, one should not only consult an ophthalmologist, but also or even primarily a dermatologist. An inflammatory skin disease is also called eczema in the technical literature.

Eczema, if it occurs in the area of the eyes, can also lead to inflammation of the eyelids (so-called blepharitis). Eczema is the most common skin disease of all, its manifestations are numerous and fortunately it is not contagious. The most common eczemas are allergic contact dermatitis, atopic dermatitis (sometimes also called atopic eczema, but better known in this country as neurodermatitis) and seborrheic dermatitis (seborrheic eczema).

Other skin diseases such as rosacea can also promote inflammation of the eyelid and eyelid margin.The classic symptoms of acute eczema are itching and usually severe redness of the skin, blistering or small nodules, swelling and the formation of crusts. In the course of the disease, the skin thickens on the surface and becomes dry and cracked. If such eczema occurs on the eyelid, the edge of the eyelid or the corner of the eye (pain in the corner of the eye), it is usually particularly unpleasant and sometimes painful.

A doctor should therefore always be consulted – on the one hand to get to the bottom of the problem and to be able to exclude serious diseases. On the other hand, also to alleviate the symptoms and prevent complications. The inflamed eyelid skin is also a welcome place for parasites such as lice and mites, which find ideal living conditions here and can spread quickly.

As already mentioned, the most frequently occurring inflammatory complaints on eyelids are caused either by a grain of barley or a hailstone. Both diseases are harmless events that are easy to treat. So what is the difference between one and the other?

In principle, in both cases it is a blocked sebaceous gland inside the eyelid, in one case it is only the swelling caused by the disturbed drainage, in the other case there is an inflammation in addition to the swelling. A hailstone, also called chalazion, is caused by one of the numerous small sebaceous glands inside the eyelid becoming blocked. These glands normally ensure, through their sebum production, that both the eyelid and the eyelashes remain smooth and supple and that no unnecessary and disturbing friction between them and the eye can occur.

The glandular bodies themselves are located inside the eyelid, their ducts open out on the inner side of the eyelid, i.e. facing the eye, as well as hidden between the lashes at the edge of the eyelid. Since they are very small, it can easily happen that one of these ducts becomes blocked and the secretion produced can no longer drain off. It accumulates in the gland, which swells and a tight knot forms in the eyelid.

This is then visible as a small nodule near the edge of the eyelid or even a small piece of it. The skin may be reddish or shimmer slightly pale purple, which is due to the fact that the swelling causes the skin to become tighter and thus thinner. Such a hailstone does not cause any pain, nor does it usually cause any other accompanying symptoms (unless the hailstone swells so much that it impairs vision or its position and size prevent the eye from being completely opened or closed).

In exceptional cases, conjunctivitis may also be observed. But apart from that, such a hailstone is absolutely harmless and does not require any further medical treatment. The swelling will last for a few days to weeks and will then disappear on its own.

If this is not the case, i.e. if the hailstone persists for an unusually long time or if pain or severe impairment of vision occurs in the course of the hailstorm, a specialist in ophthalmology should be consulted, who can then advise the patient on the further procedure. Anti-inflammatory ointments or eye drops, for example, can be prescribed against the inflammation itself. Irradiation with a red light lamp is also often helpful, as the heat helps to loosen the congestion of secretions and the swelling disappears more quickly.

If these treatment attempts are also unsuccessful, the surgical route can be taken. A hailstone operation is a small routine procedure that is performed under local anesthesia. The doctor then makes a very small incision above the area of the hailstone and can thus completely remove the inflamed and diseased tissue.

Because the incision is so small, it is not even necessary to suture it. Only an antibiotic ointment is applied to prevent infection and for the rest of the day the patient wears a bandage over the eye. The advantage of a surgical intervention is that the tissue removed can then be sent for examination, thus ensuring the diagnosis of hailstones and ruling out other, more malignant diseases.

If a patient is frequently afflicted by hailstones, it is recommended to improve eye hygiene. It is best to clean the eyes and eyelids daily, not excluding the eyelashes. With the help of a magnifying mirror and a cotton swab (moistened with warm water), this is quickly done.In addition, if it seems necessary, one can have the doctor prescribe nurturing and antibiotically effective ointments, which are then applied to the edge of the eyelid.

If there is still no improvement, antibiotic treatment in the form of tablets can be considered. Contact lens wearers should be particularly careful with their eyelids and should also go for regular ophthalmological check-ups. Other diseases such as diabetes mellitus, acne or rosacea can also cause hailstones to form.

The family doctor should be informed about this in order to be able to recommend preventive measures accordingly. A hailstone is very similar to a barleycorn. Also here it concerns a problematic tallow gland of the eyelid.

An essential difference to the hailstone is, however, that in the case of the barleycorn the secretion does not simply accumulate and cause swelling, but that the gland is inflamed by an infection with bacteria (in most cases it is bacteria of the genus Staphylococcus aureus, a classic skin germ). The symptoms of a barley grain are very similar to those of a hailstone: the affected gland swells and the skin is reddened. However, due to the infection, the swelling is painful and pus forms, which initially collects encapsulated in the tissue, but this capsule (abscess) can later open spontaneously and the pus drains away.

As soon as this happens, the barleycorn can usually heal without problems and without consequences. Therefore it is not necessary to treat the patient in a big way, time and patience is the best weapon here as well. However, to prevent the bacteria from spreading or the infection from getting worse, the doctor can prescribe antibiotic-containing drops or ointments.

It is important that the person affected does not get any foreign bodies in his or her eye (even fingers count as foreign in this case). In general, children are more frequently affected by barley grains than adults. This may be due to the fact that at a young age one does not yet independently pay attention to minimum hygienic standards and that the little ones often rub their eyes with their dirty fingers and can thus transport the germs to places where they have no business to be.

It is therefore important to encourage the offspring to pay more attention to their own behavior. Once a grain of barley is there, it is important that the child has a towel that is strictly separated from the rest of the family to avoid that other family members can also be indirectly infected. An already weakened immune system also increases the risk of a barleycorn breaking out, for example in the case of those suffering from diabetes mellitus, and should be discussed with the family doctor. As always, contact lens wearers must pay attention to tightened hygiene around the eyes, as the risk of introducing germs is much higher here.