Eyelid skin problems

Introduction

Although the eyelids can be involved with many skin conditions, the most common are listed here.

Skin lesions

Painless and stable solitary lesions

• Mole (melanocytic nevus), including congenital melanocytic nevus

• Seborrheic keratosis
• Freckles and brown marks
• Chalazion (lipogranulomatous inflammation of the Zeis sebaceous gland at the base of the eyelash, or meibomian gland on the inner aspect of the cap; due to occlusion) – a firm, painless swelling

• Salmon patch (angel kiss)

• Suderiferous cyst (transparent papule containing clear fluid)
• Other types of cysts
• Trichoepithelioma

Growth of solitary lesions

Skin cancers progressively enlarge.

• Basal cell carcinoma
• Actinic keratosis
• Intraepidermal carcinoma
• Scaly cell carcinoma
• Keratoacanthoma
• Atypical fibroxanthoma
• Sebaceous carcinoma
• Melanoma

Multiple injuries

• Skin tags
• Actinic keratosis
• Xantelasma palpebrum
• Syringoma
• Cysts
• Milia
• Moniliform blepharrhosis in lipoid proteinosis (extremely rare)

Infections that affect the eyelids.

Bacterial skin infections

• External hordeola (sty, infection from the tab follicle, usually caused by staphylococcus bacteria )
• Internal hordeola (meibomian gland infection)
• Bacterial conjunctivitis
• Erysipelas or preseptal or orbital cellulitis (infections of the tissues around the eye), which is often due to the spread of the infection to the sinuses (responsible for orbital cellulitis), respiratory tract, impetigo, abscesses, traumaor insect bites

Viral skin infections

• viral conjunctivitis

• Herpes simplex (caused by the cold sore virus)

• Herpes zoster ophthalmicus (shingles, caused by the chickenpox virus)

• Viral warts
• Molluscum contagiosum

Fungal skin infections

• Tinea faciei
• Kerion

Infestation

• Demodex Pinch eyelash infestation

• Pediculosis pubis (pthiriasis), also called crabs or pubic lice

Inflammatory skin conditions that affect the eyelids

Dry itchy patches

• Blepharitis
• Atopic dermatitis
• Allergic conjunctivitis and keratoconjunctivitis

• Contact dermatitis, including irritating and allergic contact dermatitis

• Seborrheic dermatitis
• Psoriasis

Dry itchy patches

• Discoid lupus erythematosus
• Psoriasis

Papules and pustules

• Ocular rosacea
• Blepharitis
• Periorificial dermatitis
• Acne agminata

Acne vulgaris tends to avoid the eyelids.

Blisters and erosions

• Stevens Johnson syndrome – toxic epidermal necrolysis
• Cicatricial pemphigoid
• Pemphigus vulgaris
• Erosive lichen planus

Swelling

• Contact dermatitis
• Atopic dermatitis/eczema
• Blepharitis
• Photosensitive contact dermatitis (usually avoids folds and upper eyelids), including drug-related photosensitization
• Angioedema or urticaria
• Rosacea
• Orofacial granulomatosis
• Sinusitis
• Conjunctivitis
• Injuries including swelling after surgery or cryotherapy
• Ascher syndrome

Systemic Disorders can mimic eyelid disease by causing swelling or redness of the eyelid:

• Dermatomyositis
• Myxedema
• Thyroid eye disease
• Superior obstruction of the vena cava
• Sjogren's syndrome
• Granulomatosis with polyangiitis
• Churg-Strauss vasculitis
• Amyloidosis
• IgG4-related disease
• Orbital and ocular lymphoid hyperplasia
• Orbital attached lymphoma
• Idiopathic orbital inflammatory disease

Dry and irritated eyes

• Keratoconjunctivitis sicca

Discoloration

• Dark circles under the eyes