Myokymia (pronounced mai-ow-KAI-mee-uh) is the medical term for eye twitching. It’s a common problem experienced by almost everyone at some point in their lives.

During myokymia, tiny involuntary contractions occur in a muscle of one eyelid. This looks like a “twitch” from the outside. Eyelid spasms usually happen in the lower eyelid, but they can happen in the upper eyelid too.

Types of eyelid twitches

There are three common types of eye twitching: general eyelid spasm, essential blepharospasm and hemifacial spasm. The types are organized by the severity of the twitch and whether other areas of the face are affected.

Eye twitch or tic (general eyelid spasm)

When you think of an “eye twitch,” you’re probably picturing a general eyelid spasm. This is a slight, temporary pulsing or flickering of the eyelid.

General eye spasms are usually unilateral, meaning they only affect one eye at a time. However, it’s possible for both eyes to experience a general spasm. Depending on which eye muscle is affected, you may have under eye twitching or a twitch in the upper eyelid.

Fatigue, too much caffeine or physical or emotional stress usually cause a general eye spasm. It is common, does not affect vision and will likely go away on its own.

While eye spasms can be annoying, they’re almost never cause for concern. They can last anywhere from a few moments to several days and usually go away on their own. In rare situations, spasms can last for months or even longer.

Eye twitching is a movement or spasm of the eyelid or eye muscles that can't be controlled. There are different types of eye twitching. Each type of twitch has a different cause.

The most common type of eye twitching is called myokymia. This type of twitch or spasm is very common and happens to most people at some point. It can involve either the upper or lower eyelid, but usually only one eye at a time. The eye twitching can range from barely noticeable to irritating. The twitching usually goes away within a short time but could happen again over a few hours, days or longer.

Another type of eye twitching is known as benign essential blepharospasm. Benign essential blepharospasm starts out as increased blinking of both eyes and may lead to the eyelids being squeezed shut. This type of twitching is uncommon but can be extremely severe, affecting all aspects of life.

Hemifacial spasm is a type of twitching that involves muscles on one side of the face, including the eyelid. Twitching may start around your eye and then spread to other parts of the face.

Myokymia can occur as the result of certain aspects of your lifestyle or due to conditions that irritate your eyes. Irritants can also cause your eyes to twitch more often or for longer periods of time.

Potential causes of eye twitching include:

• Stress

• Anxiety

• Exercise

• Fatigue

• Caffeine use

• Certain medication, such as topiramate, clozapine, and flunarizine, though this is uncommon

• Dry eyes

• Eye strain

• Alcohol use

• An outdated vision prescription

• Tobacco use

• Poor diet

• Eye allergies

• Dehydration

An eye spasm is rarely the result of an underlying illness. However, it may be present alongside some other conditions, including:

• Brain damage caused by inflammation or stroke

• Parkinson’s disease

• Autoimmune disease, like multiple sclerosis (MS)

• Head trauma

• Brain tumor or lesion

These are very unlikely to cause eye twitching in the average person. Usually, if an underlying condition is to blame, there will be other symptoms present with the eye twitch.

Reference:

• mayoclinic.org/symptoms/eye-twitching/basics/definition/sym-20050838
• allaboutvision.com/symptoms/eye-twitching/myokymia
• allaboutvision.com/en-au/conditions/eye-twitching

What causes Chalazion and Styes?

• Chalazion forms when an oil gland in the eyelid becomes blocked from blepharitis (eye dandruff).
• Styes are caused by bacterial infections. Usually, the bacteria grows at the root of the eyelash.

What is the difference between chalazion and stye?

Stye and chalazion are eyelid bumps that may occur at any age.

A chalazion is noticed as a bump on the eyelid. It is painless.

A stye is painful and mostly forms at the edge of the eyelid. There may be associated swelling of the eyelid.

An internal stye (hordeolum) is an inflamed and infected oil gland on the inner edge of your eyelid. Symptoms include eyelid pain, tenderness and swelling. Your eye may also tear up a lot. Treatment starts with home remedies like using a warm compress. If the stye doesn’t go away in about a week, you may need a minor procedure to drain the stye.

When you have an internal stye, an oil gland swells up and forms an abscess (pocket of pus). This leads to pain and other symptoms. While the stye may go away on its own, some people need a minor procedure to drain the pus and clear the inflammation.

Primary care providers often see and diagnose styes. Your provider may refer you to an ophthalmologist or optometrist if your stye isn’t going away or is getting worse.

What is the difference between an external stye and an internal stye?

The main difference is where they’re located on your eyelid. An external stye forms on the outer edge of your eyelid. It faces outward and looks a bit like a small pimple. An internal stye develops on the inner side of your eyelid. It faces inward, toward your eyeball. An internal stye looks like a small bump, and it may be yellowish or white.

Internal styes are usually more painful and last longer than external styes.

Reference:

• my.clevelandclinic.org/health/diseases/24478-internal-stye
• rehmansiddiqui.com/stye-and-chalazion

The orbicularis oculi is an orbital muscle of facial expression. It plays a key role in closing the eyelids and thus protecting the cornea from damage. Attachments – Originates from the medial orbital margin, the medial palpebral ligament, and the lacrimal bone.

• Attachments – Originates from the medial orbital margin, the medial palpebral ligament, and the lacrimal bone. It inserts onto the skin around the margin of the orbit as well as the tarsal plates of the eyelid.
• Actions:
  • Palpebral part – gently closes the eyelids.
  • Lacrimal part – involved in the drainage of tears.
  • Orbital part – tightly closes the eyelids.
• Innervation – Temporal and zygomatic branches of the facial nerve.
• Blood supply – Branches of the maxillary, superficial temporal, facial and ophthalmic arteries.

What does the orbicularis oculi muscle do?

The orbicularis oculi is a sphincter-like muscle that overlies the orbital rim and eyelids, and functions to close the upper and lower lids. It is separated into an orbital and palpebral segment.

The orbicularis oculi muscle closes the eye and supports the lower eyelid. When a significant part of the orbicularis oculi muscle in the upper eyelid is lost, function can be near normal. In contrast, a similar major defect in the lower eyelid requires reconstruction to prevent ectropion. This is performed with a flap that may include the orbicularis oculi muscle.

With electromyographic studies, Lowry et al. have shown that the orbicularis oculi muscle transferred as a bipedicled flap to the lower eyelid remains active.

If the lower eyelid remains positioned too low, one may insert a tendon (e.g., palmaris longus tendon) or fascial strip while fixing its edges at the medial and lateral canthus that serves as a hammock.

What is the eyelid crease?

The eyelid crease is formed with a natural connection between the muscle that lifts the upper eyelid called the levator muscle which connects to the eyelid skin with a fibrous connection. The point of this connection is where the eyelid folds when the eyes are open, forming the eyelid crease.

What is the ideal height of the eyelid crease?

Mentioned previously, the ideal location of the eyelid crease is 6 to 8mm above the lid margin. This unnatural appearance can be caused by adhesions between the orbicularis and the skin above the level of surgical fixation. High folds can also be the result of overly aggressive resection of preaponeurotic fat pads.

How do eye muscles work? eResearch by Navid Ajamin -- autumn 2024

The six external muscles of your eyes work in pairs. When one muscle moves, its partner in the same eye helps control and balance that movement. That’s why your eyes can only turn so far.

There’s also another type of paired movement that happens involving both of your eyes. Experts call this “yoking” because your eyes turn together like a pair of horses or oxen yoked together. That’s how your eyes turn in unison.

Nerves that control these muscles

The muscles that control your eye movement depend on signals that travel through three cranial nerves:

• Cranial nerve III (CN III): This is also known as the oculomotor nerve. It controls the movements of the superior, inferior and medial rectus muscles, and also the inferior oblique muscle.
• Cranial nerve IV (CN IV): This is known as the trochlear nerve. It controls the superior oblique muscle.
• Cranial nerve VI (CN VI): This is the abducens nerve. It controls the lateral rectus muscle.

What nerve controls orbicularis oculi?

The orbicularis oculi muscle is innervated by cranial nerve VII (the facial nerve). Contraction of the palpebral portion closes the eyelid gently, and the palpebral orbicularis is the muscle of action in an involuntary blink and a voluntary wink; relaxation of the levator muscle follows.

Reference:

• my.clevelandclinic.org/health/body/eye-muscles
• allaboutvision.com/eye-care/eye-anatomy/eyelid
• teachmeanatomy.info/encyclopaedia/o/orbicularis-oculi
• sciencedirect.com/science/article/abs/pii/S1748681509004094
• sciencedirect.com/topics/neuroscience/orbicularis-oculi-muscle
• eyewiki.org/Asian_Blepharoplasty_(Double_Eyelid_Procedure)
• prasadcosmeticsurgery.com/how-is-a-double-eyelid-crease-created
• linkedin.com/pulse/structures-surrounding-eye-gaush-medical-corporation
• docfinderkorea.com/news/things-to-know-for-a-successful-double-eyelid-surgery

See also:

• Why are my eyelids so uneven?
• What are the eyelid abnormalities in children?
• Why are my eyes different in the morning?
• Why are my eyelids hooded in the summer?

An external stye or sty /ˈstaɪ/, also hordeolum /hɔrˈdiːələm/, is an infection of the sebaceous glands of Zeis at the base of the eyelashes, or an infection of the apocrine sweat glands of Moll. External styes form on the outside of the lids and can be seen as small red bumps. Internal styes are infections of the meibomian sebaceous glands lining the inside of the eyelids. They also cause a red bump underneath the lid with only generalized redness and swelling visible on the outside. Stys are similar to chalazia, but tend to be of smaller size and are more painful and usually produce no lasting damage.

They contain water and pus and the bacteria will spread if the stye is forcefully ruptured. Styes are characterized by an acute onset and usually short in duration (7–10 days without treatment) compared to chalazia that are chronic and usually do not resolve without intervention. Styes are usually caused by staphylococcus aureus bacterium.[1]

Causes

1) Poor Hygiene: A stye is commonly caused by a bacteria called staphylococcal aurous (which will develop at the root or follicle of your eyelash), though other bacteria can also cause a stye. Staphylococcal aurous is a bacterium commonly present in the nose and can spread towards the eye if a person rubs the nose and touches the eye area. So besides disgusting those who have to witness this (not to mention obliterating any chances of ever getting a girlfriend), picking your nose can lead to the development of a stye. So don’t do it! Also, in general, if you touch your eye with unwashed or unclean hands, then you are putting yourself at greater risk of getting a stye.

2) Eyelid Inflammation: If you have chronic inflammation along the edge of your eyelid, it may be caused by a condition called blepharitis which makes you more susceptible to getting a stye.

3) Seborrhea: This is excessive oily discharge from glands that can increase the likelihood of developing a stye.

Factors that contribute to the blockage of glands can include:

a. Not completely removing eye makeup

b. Using outdated, or infected (shared) eye makeup

c. Hormonal changes

d. Stress

How to Cure Stye [2]

Most of the time, a stye does not necessarily require any treatment, and will go away on it’s on. But here are some helpful hints to prevent and get rid of your stye. eResearch by Navid Ajamin -- spring 2013

1. Warm Compress: Apply a clean, warm washcloth to the affected area for 10-15 minutes, 3-6 times each day (or whatever you are comfortable with). A stye often needs to be NATURALLY ruptured to drain the fluid in it and a warm compress naturally speeds up the process. A warm compress also help the stye heal faster. (Note: Never attempt to pop or rupture a stye yourself. Doing so can cause a secondary infection or make your condition worse.)
2. Antibiotics: An antibiotic like Neosporin can be applied to the stye and surrounding area (apply with clean hands) to combat the bacteria that is causing your stye. And if your stye is not going away, then you should see your doctor who will likely prescribe antibiotic eye drops or another form of topical antibiotic cream to apply to your eyelid. If the infection persisted, even after the creams, then your doctor may recommend antibiotics in pill form.
3. Surgery: If the stye does not rupture on its own, then your doctor may recommend lancing or draining the stye to relieve pressure and pain. Again, this should e done by your doctor; do not attempt this yourself.
4. Wash Your Hands: As indicated above, a stye is generally caused by bacteria called staphylococcal aurous, which also happens to be one of the most common bacteria found on human skin. Because of this, it’s a good idea to wash your hands before touching your face, especially after being out in a public space.
5. Makeup: If you use eye makeup, it’s important that you fully clean it off of your face each night before going to sleep; otherwise it can act as a contributing factor to the formation of a stye. Also, be weary of sharing eye makeup with others, as you do not want to put their eye bacteria into your eye, and vice versa.

6. Topical ointments and eye drops: Erythromycin ophthalmic ointment is the most commonly prescribed topical antibiotic for styes. Another common option is bacitracin ophthalmic ointment. Erythromycin is a bacteriostatic drug, which means it prevents the growth of bacteria.

گل مژه (‌sty) به صورت یک توده متورم ، حساس و دردناک و قرمز رنگ در نزدیکی لبه پلک تظاهر می‌کند. این توده در حقیقت یک آبسه کوچک با سر زرد رنگ است که در اثر عفونت یا التهاب ریشه مژه‌ها یا غدد ترشح کننده چربی پلک ایجاد می‌شود. از جمله عوامل ایجاد گل مژه باکتری چرکی به نام استافیلوکوک است و تماس با دستهای آلوده نیز سبب سرایت آن می‌شود.

گل مژه یا هوردئولوم hordeolum (عفونت غدد پلک) را به دو نوع داخلی (داخل لبه پلک) و خارجی (خارج لبه پلک) تقسیم می‌کنند. نوع داخلی گاهی به سمت پوست و گاهی به سمت ملتحمه چشم است. ولی نوع خارجی همیشه به سمت پوست است. شالازیون مثل گل مژه داخلی است. ولی علائم التهابی و علائم آبسه (درد و قرمزی و تورم) ندارد. و عبارت است از التهاب گرانولوماتو، مزمن، استریل (بدون عفونت) وبا علت نامعلوم در غدد چربی پلک.

گل مژه

گل مژه التهاب غدد لبه پلک در چشم است که بروز مداوم آن نشان دهنده ضعف سیستم ایمنی است. این التهاب غالبا عفونی و بسیار دردناک است. گل مژه بیماری شایعی است که می‌تواند افراد را در سنین مختلف گرفتار کند. تماس دست آلوده با چشم (به خصوص اگر با ترشحات بینی آلوده شده باشد) و التهاب لبه پلک (بلفاریت یا شوره پلک) از عوامل مهمی هستند که باعث بروز گل مژه می‌شوند.

علائم و نشانه‌ها

• ایجاد یک توده برجسته قرمز رنگ دردناک در لبه پلک
• احساس سنگینی و درد پلک
• سوزش و خارش و اشکریزش
• گاهی خروج ترشحات چرکی از گل مژه
• تاری دید: تاری دید از عوامل معمول گل مژه نیست اما اگر گل مژه نسبتاً بزرگ باشد با فشار روی قرنیه باعث ایجاد آستیگماتیسم و تاری دید می‌شود.

درمان

اکثر گل مژه‌ها ظرف چند روز به تدریج بهبود می‌یابند و مشکل خاصی ایجاد نمی‌کنند. در چند روز اول، استفاده از کمپرس گرم باعث تسکین درد می‌شود و ممکن است به سر باز کردن گل مژه و تخلیه ترشحات چرکی کمک کند. برای این منظور یک حوله تمیز را با آب جوشیده گرم (نه داغ!) مرطوب کنید و برای مدت 10 تا 15 دقیقه روی چشم مبتلا قرار دهید. ماساژ ملایم هم به تسکین درد و تخلیه ترشحات کمک می‌کند. ماساژ کمپرس گرم را می‌توان روزی 4-3 بار انحام داد تا ترشحات تخلیه شود و گل مژه بهبود پیدا کند.

هرگز سعی نکنید گل مژه را بترکانید یا به زور تخلیه کنید، این کار می‌تواند باعث گسترش عفونت به بافتهای مجاور و یا حتی ورود عفونت به مغز شود. اگر پس از چند روز (تقریبا 2 روز) گل مژه بهبود پیدا نکرد حتماً به چشم پزشک مراجعه کنید. چشم پزشک می‌تواند در صورت لزوم با یک جراحی کوچک گل مژه را تخلیه کند. تخلیه گل مژه با بی‌حسی موضعی با استفاده از قطره بی‌حس کننده انجام می‌شود. در گل مژه‌های معمولی استفاده از قطره‌های آنتی‌بیوتیک می‌تواند کمک کننده باشد. اما در بچه‌های کوچک یا افرادی که گل مژه‌های شدیداً ملتهب دارند ممکن است لازم باشد با نظر چشم پزشک آنتی‌بیوتیک خوراکی برای جلوگیری از گسترش عفونت به بقیه پلک و قسمتهای مجاور استفاده شود.

پیشگیری

در برخی از افراد گل مژه مکرراً عود می‌کند. برای پیشگیری از عود گل مژه:

• از تماس دست آلوده با چشم جلوگیری کنید.

• بهداشت پلک را رعایت کنید. شستشوی منظم پلکها با آب ولرم یا شستشوی لبه پلک با شامپو بچه رقیق شده می‌تواند به جلوگیری از عود گل مژه کمک کند.

در صورت بروز گل مژه‌های مکرر حتماً به چشم پزشک مراجعه کنید. گاهی اوقات بیماریهای چشمی دیگر مثل بلفاریت (التهاب لبه پلک) یا مشکلات غدد ترشح کننده چربی باعث بروز گل مژه مکرر می‌شود که تشخیص و درمان این بیماریها توسط چشم پزشک باعث جلوگیری از عود گل مژه می‌شود. به علاوه گاهی اوقات بعضی از بیماریهای جدی چشمی (مثلاً تومورها) ممکن است به صورت گل مژه‌های مکرر تظاهر کند که در این موارد معاینه توسط چشم پزشک راهگشا است.[3]

Reference:

1. en.wikipedia.org/wiki/Stye
2. howtocuremy.com
3. daneshnameh.roshd.ir
4. allaboutvision.com/conditions/styes.htm
5. allaboutvision.com/treatments-and-surgery/drugs-and-medications/stye-medicine
6. mayoclinic.org/diseases-conditions/sty/diagnosis-treatment/drc-20378022

See Also:

• The Facts on Styes
• How to Get Rid of a Stye
• Understanding Styes -- Prevention
• Styes - Causes, Symtoms, Treatment, Diagnosis, Condition

Puffy eyes are the bane of most women's existence. No one wants puffy eyes! The culprit? Could be anything. Too much salt the day before. Too little sleep. Who knows? For one reason or another, you wake up to find you have puffy eyes... and you want to get rid of them.

Puffy eyelids make you look tired and old. While they are usually temporary, they may last days or even weeks. If you are sick or puffy eyes result from irritation, you may find your eyes persistently take on a marshmallow like appearance. What can you do? First and foremost, don't fret! Let's look at the puffy eyes phenomena more in detail to figure out what we can to do help.                     eResearch by Navid Ajamin -- spring 2012     

Puffy Eyes Causes
What causes puffy eyes? There are all manner of insidious reasons people develop puffy eye syndrome. Here are some typical causes for puffy eyes:

• Fluctuating hormone levels, increasing the likelihood your body will retain fluid around the thin skin underneath your eyes.
• Edema or fluid retention throughout the body. Some causes for this include illness, inflammation and fatigue. Pregnancy also causes increasing edema in women.
• Dehydration, whether from drinking too little water or from a hangover. Either way, the only cure is more water.
• Puffiness resulting from medication use.
• Heredity (yes, your genes can influence your susceptibility to puffy eyes!).
• Allergies, which may also result in itchiness and redness of the eyes and surrounding tissue.

Because the skin underneath our eyes is so delicate, there are almost too many causes to list. Your best bet in the fight against puff? Treat your eyes like queens. That means getting plenty of rest, and avoiding excessive irritants. Consider the skin around your eyes as you would the skin of a newborn baby, and you'll go a long way toward combating under eye puffiness. Let's learn more about eye puffiness...

Signs and Symptoms
What are some of the more common signs and symptoms of puffy eye syndrome? Here are just a few:

• Swelling under the eyes or around the eyes and eyelid.

• Bags or excessive skin under the eyes that appears to puff out or hang.

• Itchy, red or irritated eyes.

• Inability to open or close eyes completely due to puffiness.

• Dark circles accompanied by sagging skin under the eyes.

How one defines puffy eyes really depends on the person. For some a slight discoloration in the early morning is enough to qualify for puffy eye syndrome. For others, puffy eyes are described only when giant water sacks hang from beneath their peepers. You know best how to quantify your eyes and thus are the best judge of whether you suffer from puffy eye syndrome.

Reducing Puffy Eye Syndrome
Fortunately, you don't have to live with puffy eye syndrome. In fact, if you have puffy eyes because you retain fluid, the simplest way to reduce puffiness is by drinking more water. There are other tips you can follow to help relieve puffy eyes depending on the cause. Here are a few:

• Try applying some hemorrhoid cream under the thin skin of the eye. This cream contains anti-inflammatory agents that can help alleviate puffy eyes.

• Gently tap your skin where puffy, as this can encourage fluid build up to release and drain more easily.

• Apply cold compresses to your eyes. Many stores and boutiques sell gel filled eye packs. Stick them in the freezer for a few minutes and apply to your eyes.

• Grate some potatoes or place cucumber wedges on your eyes, and lay down for 10 minutes. This may help reduce swelling and help brighten your skin.

• Soak a cloth or some nursing pads in cold milk and apply over your eyes for 10 minutes. This will help reduce puffiness and, like above, help brighten dark circles under your eyes.

• Drink water until you feel like a water fountain. When you are retaining fluid, you simply can't drink enough water to reduce puffiness. Also avoid beverages with lots of caffeine and bubbly beverages including soda, as these can contribute to edema.

• Avoid artificial sweeteners, as these can cause your body to retain more fluid.

• Be sure you are getting at least 8 hours of sleep at night, because too little sleep will lead to dark circles and puffiness.

• Try an ordinary ice pack. The cold temperature may help reduce swelling.

• Always wear UV sunglasses during the day. Apply sunscreen at least 30 minutes before going outside, even on cloudy days. Excessive exposure to the sun or unexpected sunburns often contributes to puffy eyes and leave you feeling bloated the next day.

• Avoid overly windy conditions. Wear glasses or goggles to help protect your eyes and act as a buffer against intense environmental conditions. 

Reference: eyedoctorguide.com/eye_problems/puffy_eyes_puffy_eyelids.html

افتادگی پلک چیست ؟

این بیماری به افتادگی پلک فوقانی اطلاق شده و می تواند یک یا هر دو پلک را در گیرد . در فرم خفیف بیماری افتادگی پلک در حد بالای مردمک چشم می باشد ولی در موارد شدیدتر افتادگی پلک منجر به پوشاندن قسمتی از مردمک شده به طوری که میدان بینایی فوقانی را کاهش می دهد .

پتوز می تواند یک یا هر دو چشم را درگیر کند. وراثتی باشد.در بدو تولد بروز کند.در سنین بالاتر اتفاق بیفتد.

بارزترین علامت پتوز یا بلفاروپتوز خود افتادگی پلک است. سایر علائم عبارتند از مشکل در باز کردن چشم یا نیاز به کج کردن سر به عقب برای بهتر دیدن. خستگی چشم، انحراف چشم، یا دوبینی نیز می‌توانند به همراه پتوز ( افتادگی پلک فوقانی ) اتفاق افتند.

علل افتادگی پلک چشم گوناگونند. برخی ممکن است با افتادگی چشم موروثی متولد شوند، که به آن پتوز (افتادگی پلک فوقانی) مادرزادی گفته می‌شود. اکثر موارد پتوز اکتسابی با بالا رفتن سن و در نتیجه کشیده شدن و شل شدن تاندونی که پلک را باز نگه می‌دارد، ایجاد می‌شوند.

Eyelid Structures

SKIN

• The eyelid skin is the thinnest in the body.

• The skin contains fine hairs, sebaceous glands, and sweat glands.

EYELID FOLDS

• In non-Asians, the levator palpebrae superioris muscle has some attachments to the upper border of the tarsus, which forms a superior eyelid fold.

• In non-Asians, the levator palpebrae superioris muscle does not have these attachments, so the superior eyelid fold is minimal or absent.

SUBCUTANEOUS CONNECTIVE TISSUE

• The significant eyelid swelling seen in conditions such as preseptal cellulitis (shown above) is caused by the accumulation of fluid in the loose connective tissue.

various layers of the eyelid :

• Skin
• Subcutaneous connective tissue (the Oculoplastics BCSC book lumps the skin and subcutaneous tissue into one layer, as clinically they are fairly indistinct)
• Orbicularis oculi muscle
• Orbital septum
• Levator palpebrae superioris muscle (not present in the lower eyelid)
• Müller muscle (inferior tarsal muscle in the lower eyelid)
• Tarsus
• Conjunctiva

TYPES OF PTOSIS [7]

According to the onset of ptosis can be:

• intrinsic
• acquired

According to the cause it can be:

• Aponeurotic ptosis: It is most often involuntive as a result of the aging process. The upper eyelid is lowered on both sides and asymmetrically with worsening ptosis throughout the day. The upper eyelid levator muscle function is usually normal.
• Myogenic ptosis: It is caused by a disorder of the upper eyelid levator muscle itself or by a disorder at the neuromuscular junction. It is most often the first sign of myasthenia gravis disease. The eyelids are lowered on both sides and asymmetrically, worsening during the day and recovering after rest.
• Neurogenic ptosis: Most often it is unilateral, due to impaired brain nerve function responsible for eyelid movement or sympathetic nerves.
• Mechanical ptosis: It is caused by impaired motility of the upper eyelid with orderly nerve and muscle function.
• Traumatic ptosis is a consequence of the upper eyelid injury.

What is congenital ptosis [8]

Congenital ptosis also called congenital blepharoptosis, is a drooping eyelid that is present at birth or within the first year of life. Congenital ptosis is usually present at birth but may manifest within the first years of life. In ptosis, the upper eyelid falls to a position that is lower than normal. In severe cases of ptosis, the drooping eyelid can cover part or all of the pupil and interfere with vision, resulting in amblyopia.

Amblyopia may result from obscuration of the vision directly or from development of astigmatism indirectly. Development of amblyopia is an indication for immediate surgical correction.

• Occlusion amblyopia
• Astigmatism from the compression of the droopy eyelid
• Ocular torticollis

In most cases of congenital ptosis, the problem is isolated and does not affect the vision. Any ptosis that develops over a period of days or weeks can signal a serious medical problem and needs further neurologic and physical evaluation.

Although not all patients with congenital ptosis need surgical intervention, patients need to be closely monitored for the possible development of deprivational amblyopia. Since amblyopia may not be reversed after age 7-10 years, appropriate and timely medical and surgical treatment of congenital ptosis is critical to preserve the child’s vision.

Scarless ptosis surgery before and after pictures

Ptosis is a drooping of the upper eyelid. A droopy eyelid can cause blurring of vision or watering of the eye due the weight of the eyelid pressing on the front of the eye.

Congenital ptosis causes

In most cases of congenital ptosis, the cause is idiopathic (unknown).

Histologically, the levator muscles of patients with congenital ptosis are dystrophic 1). The levator muscle and aponeurosis tissues appear to be infiltrated or replaced by fat and fibrous tissue. In severe cases, little or no striated muscle can be identified at the time of surgery. This suggests that congenital ptosis is secondary to local developmental defects in muscle structure.

Congenital ptosis may occur through autosomal dominant inheritance. Common familial occurrences suggest that genetic or chromosomal defects are likely.

Other potential causes of congenital ptosis include:

• Blepharophimosis syndrome: This condition consists of short palpebral fissures, congenital ptosis, epicanthus inversus, and telecanthus.
• Third cranial nerve palsy: Signs of aberrant regeneration are usually present. The pupil may be paradoxically small and nonreactive.
• Horner syndrome: Ipsilateral findings of mild ptosis, miosis, and anhidrosis characterize this syndrome. The ipsilateral lower eyelid may be elevated. Also, because of the lack of sympathetic innervation to the iris melanocyte development, a difference in the iris color between the eyes may result (called heterochromia).
• Marcus Gunn jaw-winking syndrome: The motor nerve to the external pterygoid muscle is misdirected to the ipsilateral levator muscle. Lid elevation occurs with mastication or with movement of the jaw to the opposite side.
• Birth trauma
• Duane syndrome: In this condition, the sixth cranial nerve fails to innervate a lateral rectus muscle. Then, the muscle acquires an innervation of the third cranial nerve. Although the synkinesis produced does not involve lid innervation, enophthalmos with apparent ptosis may result. In Esotropic Duane syndrome, the upper eyelid droops further and the lower lid elevates when the eye is adducted because of a co-contraction of the horizontal rectus muscles.
• Periorbital tumor: Neuroblastoma, plexiform neuromas, lymphomas, leukemias, rhabdomyosarcomas, neuromas, neurofibromas, or other deep orbital tumors may produce ptosis or proptosis.
• Kearns-Sayre syndrome: This mitochondrial deletion disorder is characterized by progressive external ophthalmoplegia, heart block, retinitis pigmentosa, and central nervous system manifestations. This condition begins in childhood but is rarely present at birth. The conditions are most likely to become symptomatic in the first or second decade of life. Bilateral ptosis is a prominent feature of this syndrome.
• Myotonic dystrophy: Patients with this condition may present with polychromatic cataracts, gonadal atrophy, or premature thinning and/or loss of hair. Myotonic dystrophy is an autosomal dominant disorder that is characterized clinically by myotonia and progressive muscular weakness. Frontal balding and temporalis muscle wasting are also clinically evident.
• Myasthenia gravis: A defect at the neuromuscular junction produces relative unresponsiveness to released acetylcholine, resulting in ptosis.
• Pseudotumor of the orbit: Patients with this condition may present with ptosis due to inflammation and edema of the eyelid.
• Pseudoptosis: Less tissue in the orbit (eg, unilateral smaller eye, fat atrophy, blowout fracture) produces the appearance of ptosis secondary to the decreased volume of orbital contents.

افتادگی پلک همچنین می‌تواند در اثر تروما، جراحی، یا آسیب به عضلاتی که پلک را بالا می‌کشند یا اعصابی که این عضلات را کنترل می‌کنند، اتفاق افتد. تومورها، اختلالات عصبی، بیماری‌های سیستمیک، و برخی داروهای خاص نیز می‌توانند باعث به وجود آمدن پتوز (افتادگی پلک فوقانی) شوند.

بسته به علت ایجاد آن، پتوز (افتادگی پلک فوقانی) می‌تواند به صورت‌های زیر دسته‌بندی شود:

پتوز (افتادگی پلک فوقانی) نوروژنیک: به حالتی گفته می‌شود که اعصاب متصل به عضلات تحت تأثیر قرار بگیرند.

پتوز (افتادگی پلک فوقانی) میوژنیک: به حالتی گفته می‌شود که افتادگی پلک در اثر مشکلی در عضله ایجاد شده باشد که پلک را بالا می‌برد.

پتوز (افتادگی پلک فوقانی) آپونوروتیک: به حالتی گفته می‌شود که تاندون مسئول لیفت پلک کشیده شده و ضعیف شده باشد.

پتوز (افتادگی پلک فوقانی) مکانیکال: به حالتی گفته می‌شود که سنگینی پلک برای عضلات خیلی زیادتر از آن است که بتوانند بلندش کنند.

Extra-ocular muscles responsible for eye movement

عوامل متعددی ممکن است امکان ابتلای شما به پتوز (افتادگی پلک فوقانی) را افزایش دهند.

از قبیل:

• بالا رفتن سن
• زمینه خانوادگی ابتلا به پتوز (افتادگی پلک فوقانی)
• آسیب‌های ناشی از تولد
• جراحی چشم برای برداشتن آب مروارید
• فلج فیبرهای عصبی پلک‌ها
• دیابت
• ضربه
• سندرم هورنر
• ترومای سر یا پلک
• تومور مغزی
• تحلیل و فساد عضلانی
• میاستنی گراویس

در برخی موارد، برای تعیین علت پتوز (افتادگی پلک فوقانی) اکتسابی، آزمایشات پزشکی انجام می‌پذیرد. از آنجا که چند دلیل برایافتادگی پلک وجود دارد، شدیداً توصیه می‌شود که حتی اگر علائم خفیف باشند، برای تشخیص به پزشک مراجعه کنید.

پتوز در کودکان
پتوز مادرزادی به معنای وجود پتوز در بدو تولد می باشد. اگر کودکی با پتوز متوسط تا شدید متولد شود، ممکن است برای تکامل بینایی نیازمند درمان فوری باشد.
پتوز مادرزادی اغلب در اثر نقص در تکامل عضله بالابرنده پلک فوقانی که عضله لواتور نام دارد، اتفاق می افتد. اگرچه معمولا یک اختلال مجزا می باشد، ولی در موارد مادرزادی، ممکن است همراه با اختلالات زیر باشد:

- اختلال حرکات چشمی
- بیماری های عضلانی
- تومورهای پلک یا سایر تومورها
- اختلالات عصبی
- عیوب انکساری
- پتوز مادرزادی معمولا با گذشت زمان بهبود نمی یابد.

چرا این بیماری رخ می دهد ؟
این بیماری می تواند در زمان تولد تظاهر کند که افتادگی پلک مادر زادی اطلاق می شود همچنین زمانی که عضلات بالا برنده پلک تشکیل نشده باشد افتادگی پلک مادر زادی است .در نوع ناشی از افزایش سن، تاندون عضلات با لا بر پلک از محل اتصا لشان بر روی پلک جدا شده و در نتیجه افتادگی پلک رخ می دهد که معمولا در سنین بالای ۰ ۵- ۴۵ سال رخ می دهد و در اثر پوست اضافی در پلک می باشد .
علائم و نشانه های پتوز کدامند؟
شایعترین علامت آشکار پتوز در کودکان، افتادگی پلک می باشد. در پتوز مادرزادی، اغلب عدم تقارن چین پلک فوقانی وجود دارد. کودکان مبتلا به پتوز ممکن است برای دیدن مجبور شوند گردن خود را به عقب خم کنند یا ابروها را به سمت بالا بکشند. این مانورهای سر و صورت نشان می دهند که کودک سعی می کند برای دیدن از هر دوچشم استفاده نماید. بعد از گذشت چند سال، این وضعیت های غیر طبیعی سر ممکن است منجر به اختلالات ظاهری سر و گردن شوند.

مشکلات ناشی از پتوز در کودکان کدامند؟
شایع ترین اختلال جدی مرتبط با پتوز دوران کودکی، آمبلیوپی (تنبلی چشم) می باشد. به دو علت پتوز می تواند ایجاد تنبلی چشم کند:

1. انسداد مسیر بینایی در موارد پتوز شدید
2. ایجاد آستیگماتیسم و تاری دید ناشی از آن

بعلاوه پتوز ممکن است در صورت وجود انحراف چشم آن را مخفی نماید و این مورد نیز می تواند منجر به تنبلی چشم شود.

Causes & Risk Factors [2]

While most often caused by aging, there are a variety of underlying health conditions and other complications that can cause ptosis.

1. Age
2. Injury or trauma
3. Infection or tumor of the eyelid
4. Tumor inside the eye socket
5. Side effect of cataract surgery
6. Side effect of corrective eye surgery, like LASIK, PRK, LASEK, RLE and others
7. Levator muscle problems
8. Eye tumor
9. Diabetes
10. Myasthenia gravis, a rare and progressive muscle weakness disorder.Eyelid drooping is often a first sign of this condition.
11. Muscle disease like muscular dystrophy
12. Brain tumor
13. Stroke
14. Brain aneurysm
15. Horner’s syndrome
16. Cancer of the nerves
17. Bell’s palsy
18. Side effect of a Botox injection

about Ptosis Repair

Ptosis repair by external levator advancement should be performed in the operating room under monitored anesthesia care. As the patient's cooperation is required for portions of the procedure, excessive sedation should be avoided.

(a,b) Upper eyelid ptosis repair with knotted sutures (Genova et al., 2005)

Management of Complications

• Undercorrection: Undercorrection of eyelid ptosis is one of the most common complications in ptosis repair. If noted within the first 3 to 4 days and edema is minimal, the patient can be taken back to the operating room for an adjustment. If undercorrection is noted after 4 days, the patient should be followed at least 6 months before a second operation is performed.
• Overcorrection: Overcorrection of eyelid ptosis presents as lagophthalmos and can lead to corneal exposure and dry eyes; it should at minimum be treated with ophthalmic saline drops 3 to 4 times during the day and with ophthalmic ointment at bedtime. If the lagophthalmos is mild, you can treat conservatively with eyelid massage several times throughout the day. A temporary tarsorrhaphy suture may be utilized while the swelling resolves and the tissues are softened with scar massage. If the overcorrection is severe or if corneal injury is present or symptoms fail to improve within 1 to 2 weeks with conservative treatment, surgical correction is required.
• Corneal abrasion: Corneal abrasions can occur as a result of injury to the eye during surgery or post-operatively as a result of incorrectly placed sutures that irritate the eye. This is treated with ophthalmic antibiotic drops or ointment four times per day until fully healed. If the corneal abrasion is due to an incorrectly placed suture, the suture should be adjusted to avoid further corneal injury. If the corneal abrasion is severe, significant scarring can lead to decreased vision.
• Infection: Infections of the eyelid after surgery are uncommon but should be treated with oral antibiotics. If an abscess is present, incision and drainage of the site is necessary.
• Retrobulbar hematoma: Retrobulbar hematomas are extremely rare but can lead to blindness if not diagnosed and treated early. This is caused by bleeding into the post-septal compartment of the eye, resulting in acute onset of severe pain, proptosis, decreased vision and extraocular movements, dilated pupils, scotomas, and increased ocular pressure. The treatment of this condition is emergent and requires surgical exploration to evacuate the hematoma and obtain hemostasis. A lateral canthotomy under local anesthesia can be performed at the bedside while the patient is waiting to be transferred to the operating room.

Key Principles

• The upper eyelid margin normally lies 0.5 to 2 mm below the superior corneal limbus. Ptosis describes the descent of the upper eyelid margin below the normal anatomical position and is classified as mild (1–2 mm), moderate (3–4 mm), and severe (>4 mm).
• Hering's test: The Hering's test attempts to expose hidden contralateral ptosis. Manually elevating the ptotic eyelid with a cotton-tip applicator to normal position will normalize the increased neural input and unmask hidden ptosis of the contralateral eyelid, if it exists.The law proposes that conjugacy of saccades is due to innate connections in which the eye muscles responsible for each eye's movements are innervated equally. The law also states that apparent monocular eye movements are actually the summation of conjugate version and disjunctive (or vergence) eye movements.
• Fasanella-Servat or conjunctival-Mullerectomy procedures are indicated in patients with mild ptosis and moderate to good levator muscle excursion.
• Levator advancement procedure is indicated in patients with attenuation or dehiscence of the levator aponeurosis associated with mild to severe ptosis and moderate to good levator muscle excursion.
• Frontalis sling procedure is indicated in ptosis patients with poor levator function and intact frontalis muscle. This is commonly performed in children with congenital ptosis.[4]

پتوز مادرزادی چگونه درمان می شود؟
در اغلب موارد، پتوز کودکان با جراحی درمان می شود. اگر تنبلی چشم هم وجود داشته باشد، ممکن است درمان با قرار دادن پوشش بر روی چشم سالم، استفاده از عینک یا قطره چشمی ضروری باشد. تشخیص لزوم انجام جراحی و انتخاب روش مناسب،

بر اساس عوامل زیر صورت می گیرد:
- سن کودک
- درگیری یک یا هر دو پلک
- شدت پتوز
- قدرت عضلات بالا برنده و پایین آورنده پلک
- وضعیت حرکات چشمی

در اوایل دوران زندگی معمولا ضرورتی به انجام جراحی برای موارد خفیف تا متوسط پتوز وجود ندارد. هم در موارد مذکور و هم موارد شدیدی که تحت عمل جراحی قرار گرفته اند، باید به طور منظم از نظر تنبلی چشم، عیوب انکساری و حالت های وابسته توسط چشم پزشک بررسی و در صورت نیاز تحت درمان قرار گیرند. eResearch by Navid Ajamin -- spring 2012

علل پتوز بالغین چیست؟

شایعترین علت پتوز در بالغین، کشیدگی یا جداشدگی تاندون عضله لواتور از روی پلک می باشد. وقوع این فرایند ممکن است ناشی ازعلل زیر باشد:
- افزایش سن
- به دنبال جراحی کاتاراکت (آب مروارید) یا سایر جراحی های چشمی
- ضربه به چشم
پتوز بالغین همچنین ممکن است عارضه ای از سایر بیماری ها مانند بیماری های عصبی یا عضلانی و در موارد نادر تومورهای حدقه چشم باشد که عضله بالابرنده پلک یا عصب آن را درگیر می کنند
پتوز چشم راست- بعد از عمل

پتوز بالغین چگونه درمان می شود؟
چشم پزشک می تواند بررسی جامعی از مشکل شما به عمل آورده و راجع به روش های درمانی مختلف و عوارض وخطرات احتمالی آن ها اطلاعات لازم را در اختیار شما قرار دهد.
برای تشخیص علت پتوز و انتخاب بهترین روش درمانی ممکن است نیاز به انجام آزمایش خون، عکسبرداری های مخصوص و یا سایر آزمایشات باشد. در صورت یافتن علت زمینه ای باید ابتدا این مورد اصلاح گردد، اما در اغلب موارد، درمان نهایی جراحی است که نوع جراحی نیز بر اساس شدت پتوز و سایر یافته های بالینی تعیین می گردد.

Before surgery

A thorough examination should be performed preoperatively to exclude certain diseases for which surgery is not indicated.

Before the surgery, the following should be done / prepared:
• complete blood count
• small coagulogram
• allergy list (pay special attention to medication allergies)
• list of medications the patient is consuming (special attention should be paid to blood thinners such as: Aspirin, Andol, Martefarin, Warfarin, Heparin, etc.).

During the surgery

The surgery is performed under local anesthesia in adults. It lasts from 45 to 90 minutes, depending on whether surgery involves both eyelids. The surgeon makes an incision in the anterior ocular fold of the eyelid. Stitches are inserted into the muscle to strengthen its attachment to the eyelid and adjust the height of the eyelid.

After the surgery

After the ptosis surgery, it is necessary to limit certain activities for two weeks. It is also recommended to avoid eye rubbing or do anything that may cause eye irritation. The eyelid may be slightly swollen after the surgery and the eye may not be able to close completely within the first few of days.[7]

درمان این بیماران با عمل جراحی صورت می گیرد جراحانی که در این عمل مهارت دارند می توانند جراحی را تحت بیحسی موضعی انجام دهند ولی گاهی تحت بیهوشی عمومی هم صورت می گیرد. در طی این عمل اتصال عضله بالا برنده پلک با محل اتصالشان بر روی پلک مجددا برقرار می شود ولی به طور شایعتر در نوع مادر زادی عضله را کوتاه می کنند عمل اصلاح افتادگی پلک عمل بسیار ظریفی است و مدت زمان آن برای هر چشم ۴۵ دفیفه تا یک ساعت می باشد . در افتادگی پلک ناشی از افزایش سن اکثرا نیاز به عمل بلفاروپلاستی ( برداشتن پوست اضافه پلک ) نیز وجود دارد .

خطرات جراحی پتوز کدامند؟
خطرات جراحی پتوز شامل عفونت، خونریزی و کاهش بینایی می باشد، ولی وقوع این عوارض بسیار نادر است. بلافاصله بعد از عمل، ممکن است چشم بطورکامل بسته نشود، ولی این عارضه معمولا مقطعی است. در طی این مدت می توان از قطره و پماد برای محافظت چشم استفاده نمود. اگرچه ظاهر پلک بطور قابل توجهی اصلاح می شود، اما ممکن است پلک ها کاملا قرینه به نظر نرسند. در اغلب موارد بعد از جراحی در نگاه به پایین پلک عمل شده نسبت به طرف مقابل مختصری بالاتر قرار می گیرد و شب ها مختصری باز می ماند که این دو عارضه مشکل آفرین نیستند. در موارد نادر، حرکات کامل پلک قابل برگشت نیست. در برخی موارد، ممکن است بیش از یک بار عمل جراحی لازم باشد.

توصیه ׃
بیمار میبایست دو هفته قبل از عمل جراحی داروهایی که شانس خونریزی حین عمل یا پس از عمل جراحی را افزایش می دهند مثل آسپیرین، دیکلوفناک، بروفن، وارفارین ، …… را قطع نماید .

خلاصه
پتوز در بالغین و کودکان با انجام جراحی قابل درمان است و این درمان علاوه بر اصلاح وضعیت ظاهری می تواند باعث بهبود بینایی نیز شود. در پتوز کودکان، انجام معاینات منظم چشم پزشکی در سال های اول زندگی برای پیشگیری و درمان تنبلی احتمالی چشم از اهمیت ویژه ای برخوردار است.

Reference:

1. pezeshkan.org
2. draxe.com/ptosis
3. ninitime.com/several-eyelid-drainage-therapies
4. sciencedirect.com/topics/neuroscience/ptosis-eyelid
5. sciencedirect.com/topics/medicine-and-dentistry/ptosis-repair
6. ophthalmologyreview.org/bcsc-fundamentals/eyelid-anatomy
7. knezovic.com.hr/en/services/oculoplastic-and-aesthetic-procedures/ptosis
8. healthjade.net/congenital-ptosis

Swelling of the eyelids appears to be a quite common symptom many people complain about. Naturally, it gets them worried but most people do nothing and wait for the swelling to go down on its own. A few may apply a warm cloth over the swelling, other take an over-the-counter antihistamine like Benadryl or Claritin but those more anxious may start picking and squeezing and even aggravate the condition.

You may be surprised to hear that there are over 70 causes of swollen eyelids. Some quite common, others quite rare. In order to avoid any complications, you should see a doctor and abstain from self-diagnosis and especially picking or applying any over-the-counter or so-called home-made treatments.

Depending on the severity of the onset of eyelid swelling, you may decide to consult some of the following medical professionals. You will not make a mistake by choosing a general practitioner, emergency physician, ophthalmologist or dermatologist.

You should remember that diagnosis is dependable on the additional symptoms. Paying attention to additional symptoms will significantly narrow the options. If you do notice any additional symptoms, do not hold them back. It is essential you reported them to the specialist you had previously chosen to visit. This action will lead to an accurate diagnosis and successful treatment.

A doctor will probably want to know some additional things such as duration and severity of the eyelid swelling (to figure out if acute or chronic), a brief family and your own medical history (to see if any inherited disorders may be to blame), if you had taken any medication, if you had any allergic or adverse reactions before, if you had a cold or a runny nose recently (to see if it could be viral), if you had redness or some kind of eye discharge (to see if it could be bacterial) to get a better picture.

Possible causes of eyelid swelling are:

1. Allergic reactions.Swelling of the eyelids could be caused by hair spray, nail polish, make-up allergy, chemical allergy, animal and plant allergy. Animal allergies are most commonly caused by the household pets.
2. Blepharitis and chronic blepharitis. Blepharitis is an annoying reoccurring condition that causes inflammation of the eyelids. There are underlying conditions that provoke blepharitis. They are acne rosacea, dry eyes, scalp dandruff, and different infections such as staphylococcus bacteria. Symptoms indicating possible blepharitis include burning in the eye feeling, foreign body feeling, excessive tearing and itching of the eye.
3. Conjunctivitis Conjunctivitis is a contagious infection of the eye. The infection could be viral or bacterial in origin but also triggered by an allergy, environmental irritants, contact lenses and eye - drops and ointments. It usually causes swelling, itching, burning, and redness of the eye protective membrane. Conjunctivitis easily spreads from one person to another.
4. Styes Styes are enflamed sebaceous glands located near the base of the eyelashes. Most commonly caused by staphylococcus bacteria, they remind of pimples. It is important not to squeeze or pierce them so that bacteria wouldn’t spread over the entire eyelid. Washing hands is essential when applying any type of treatment on the stye because dirty hands will spread the infection.
5. Chalazion Chalazion is caused by oil glands blockage. In return, swelling of the upper or lower eyelid occurs. Additional symptoms that may appear are redness, pain, itchiness and lumpiness of the eyelid. Your doc may suggest you to wait or apply hot compress, receiving corticosteroid injection or even a surgery depending on severity.[1]

In general, swelling of the eyelids can be justified by the type of activity conducted the previous day: you have been drinking heavily before going to bed, you eat salty foods, you spent the day working in your garden head down or you slept very late at night. Most of the time, the swelling resolves in a few hours, as fluids are reabsorbed into the body.

Puffy eyes may also be an allergic reaction – you ate strawberries or you have slept on feather pillows. Hormonal changes during menstruation can also cause the problem.

The sagging skin, part of the normal aging process, can also cause swelling almost permanent. The skin around the eyes becomes thinner and loses its elasticity with age, says he. The underlying fat causes swelling to the eye. Bags under the eyes, instead of swelling may signal a thyroid condition known as Graves’ disease or indicate the presence of kidney disease.

SYMPTOM RELIEF

Perhaps you prefer to hide the swelling of the eyes under your sunglasses in the morning, but rest assured, there are other ways to alleviate the problem.

Splash your face: Flush the face with cold water stimulates blood circulation.

Relieve yourself: To tap gently with upper and lower eyelids to remove accumulated liquids in the eye. Fingertips only, lightly tap the swollen areas of your upper and lower eyelids.

Hide the problem: Refrigerate one eye mask coating of jelly, and then apply it on your closed eyes for a few minutes upon awakening. Try also with tea bags. Moisten with cold water 2 tea bags and place them over your eyes closed for 15 minutes. The tannin content in tea helps firm skin and reduces swelling. Freshness is the key element that helps reduce swelling.

Use a diuretic: If you do water retention before your period, some OTC products can help decrease the swelling.

Take an antihistamine: If your eyes are red and puffy and they are itching, maybe you suffer from an allergic reaction. In such cases, the antihistamine would help reduce the swelling.

Concealer to the rescue: To hide the swelling of the upper lid, apply a darker shade of foundation, since the brow to the crease. Then apply a lighter shade on the eyelid itself, the fold lashes. The swelling is less noticeable when stresses the lower eyelid. In the case of bags under the eyes, apply a slightly darker than your foundation usual.

PREVENTING SWELLING

Here’s how you can prevent swelling:

• Elevate the head of your bed. The wood blocks from 12 to 15 cm, placed under the headboard to elevate it, will prevent liquids from pooling in the eye.

• Do not drink before going to bed. Or drink a few sips of liquid.

• Eliminate foods high in salt.

• Forget the wrinkle. An eye cream designed to eliminate wrinkles may be too effective. This product may have the undesirable effect of accentuating the bags under the eyes, creating swelling.

• Change your makeup. The makeup water based and frosts are lighter than oil-based and appear to be less irritating to the delicate eye skin.

• Forget the feathers. If you think you are allergic to feathers, and you wake up every morning puffy eyes, get duvets and pillows made of synthetic fibers.[2]

Reference: 1.steadyhealth.com 2.sanitarian.net

Dry eyelids are an occurrence that affects many people, especially those who already have issues with dry skin. When it comes to dry, flaky skin it can sometimes be embarrassing, especially if you suffer from eczema or psoriasis. If you suffer from dry, scaly or flaky skin on your eyelids this could be the worse of these conditions, as it's extremely uncomfortable, irritating and unattractive. Before applying simple lubrications, moisturizers or lotions to your eyelids to relieve the dryness, it's important you talk to a dermatologist to find the underlying cause. There could be several different reasons or causes behind the dry skin.

Certain symptoms you might suffer from could also be a tell-tell sign of an underlying skin condition such as Blepharitis. We will go over the symptoms, causes and treatment methods of dry eyelids, as well as discuss other skin conditions that could be causing the problem below.

Symptoms of Dry Eyelids

It's not a guarantee that you will have or experience all of these symptoms. In fact, you may only experience the dryness of the eyelids and nothing else. However, there are symptoms to watch for that will let you know a certain condition might be lurking. The main ones of course are dry, flaking eyelids that can get itchy as the skin begins to peel.

Dryness Scales Itching Swelling Soreness Discoloration of skin

Causes of Dry Eyelids

Dry eyelids can be caused by many underlying problems, some maybe very minor like facial cleansers to major ones such as Sjogren's syndrome. As with the symptoms, there could be several different causes as to why one is suffering or experiencing dry, itchy eyelids and if it is a constant problem the best solution is to consult a professional. Some of the most common causes are:

• Cosmetics or Make-up (eyeliner, foundation, eye shadow)

• Shampoo

• Food

• Cleansers

• Hair Dye containing the ingredient p-Phenylenediamine

• Eyelash Curlers, the nickel body could cause irritation

• Underlying Skin Conditions

• Eczema

• Psoriasis

Underlying Conditions that could be causing dry eyelids are:

• Eyelid Dermatitis - It's known to manifest itself as an allergic reaction to something that has direct contact with ones eyelids.

• Atopic Dermatitis - This is the result of food or airborne allergens.

• Eborrheic Dermatitis - This is the result when the skin reacts to its own natural oils and bacteria.

• Blepharitis - This condition is a chronic inflammation of the eyelids, caused by excess bacteria.

Treatment for Dry Eyelids

Unlike other parts of the body, the skin around your eyes, including your eyelids is much more sensitive. Simply applying lotions or moisturizers is unsafe and not recommended by most dermatologists. Companies make specific types of gels and creams for the skin around your eyes. Using these types of lubricants can help you achieve the moisturized skin you're looking for on your eyelids. Another good treatment option is to gently wash with baby shampoo and wipe the area clean. Talk with a dermatologist, possibly one referred by an ophthalmologist, or if possible, try talking to an ophthalmologist who specializes in dermatology.

Another treatment option is to stop hanging around known allergens. This only triggers symptoms, including dryness. Discontinue use of make-up and only replace the make-up when the condition heals. Try avoiding contact with dirty surfaces with your hands. Unfortunately, many people naturally touch their face, eyes and other parts of their body without notice. Keep hands clean by constantly washing them or by applying an antibacterial gel. Wash your face twice a day, especially before bed and reapplying make-up. Warm wash clothes or warm pads can help to soften the dry skin on your eyelids, making them easier to remove.

Reference: www.eyecaresource.com/conditions/dry-eyelids.html

شالازيون‌: عبارت‌ است‌ از توده‌اي‌ روي‌ پلك‌ چشم‌ كه‌ به‌ دليل‌ عفونت‌ مزمن‌ در غدد ترشح‌كننده‌ مواد نرم‌كننده‌ لبه‌ پلك‌، ايجاد مي‌شود.

What is a chalazion?

A chalazion is a red bump on your eyelid. It's sometimes called an eyelid cyst or a meibomian cyst. It slowly forms when an oil gland (called a meibomian gland) becomes blocked. At first, the chalazion may be painful, but after a little time, it usually doesn't hurt.

When should I worry about a chalazion?

If the chalazion does not go away after several weeks, it may require medical treatment, which may include an incision to drain or an injection of steroids to reduce the inflammation and swelling.

What is the difference between a chalazion and a hordeolum?

A chalazion is caused by noninfectious meibomian gland occlusion, whereas a hordeolum usually is caused by infection.

علايم‌ شايع‌

وجود يك‌ تورم‌ بدون‌ درد روي‌ پلك‌ چشم‌ كه‌ در نگاه‌ اول‌ ممكن‌ است‌ شبيه‌ گل‌ مژه‌ باشد. امكان‌ دارد پلك‌ متورم‌ شود و فرد در چشم‌ احساس‌ ناراحتي‌ بكند. پس‌ از چند روز، اين‌ علايم‌ اوليه‌ ناپديد مي‌شوند و آنچه‌ كه‌ بر جاي‌ مي‌ماند يك‌ برجستگي‌ سفت‌، بدون‌ درد، و با رشد آهسته‌ در پلك‌ است‌. پوست‌ روي‌ اين‌ برجستگي‌ را به‌ راحتي‌ مي‌توان‌ حركت‌ داد.

علل‌

انسداد يكي‌ از مجاري‌ ارتباطي‌ غده‌ ترشح‌كننده‌ مواد نرم‌كننده‌ لبه‌ پلك‌ با سطح‌ پلك‌. انسداد ممكن‌ است‌ به‌ علت‌ عفونت‌ در اطراف‌ سر مجرا به‌ وجود آمده‌ باشد (معمولاً ناشي‌ از استافيلوكك‌).

A chalazion (/kəˈleɪziən/; plural chalazia or chalazions) or meibomian cyst is not a cyst but a granuloma in the eyelid that results from a blocked meibomian gland. It typically occurs in the middle of the eyelid, red, and not painful. They tend to come on gradually over a few weeks.A chalazion may occur following a stye or from hardened oils blocking the gland. The blocked gland is usually the meibomian gland, but can also be the gland of Zeis.

A stye and cellulitis may appear similar. A stye, however, is usually more sudden in onset, painful, and occurs at the edge of the eyelid.Cellulitis is also typically painful.

Treatment is initiated with warm compresses. In addition, antibiotic/corticosteroid eyedrops or ointment may be used. If this is not effective, injecting corticosteroids into the lesion may be tried. If large, incision and drainage may be recommended.[2] While relatively common, the frequency of the condition is unknown. It is most common in people 30–50 years of age, and equally common in males and females. The term is from Ancient Greek χαλάζιον (khalazion) 'small hailstone'.

Chalazion vs. stye

People sometimes confuse a chalazion with a stye due to similarities in appearance. Although people sometimes use the two terms interchangeably, they refer to different types of lesions that appear around the eye.

A chalazion results from a blocked oil gland, whereas a stye, or hodeolum, indicates an infected oil gland or hair follicle.

There are two ways a stye can develop. An external hordeolum occurs at the base of the eyelash. An internal hordeolum develops deeper inside the eyelid.

The most noticeable difference between a chalazion and a stye is that a chalazion tends to be painless. A stye usually hurts and may cause the eye to feel sore and scratchy. Other symptoms of a stye can include:

• a painful lump that may cause the whole eyelid to swell
• a small spot of pus, similar to that of a pimple, at the center
• crustiness along the edge of the eyelid
• a sensation that something is in the eye
• sensitivity to light
• eye watering

عوامل‌ افزايش‌ دهنده‌ خطر

بيماري‌هاي‌ پوستي‌ مثل‌ آكنه‌ روزاسه‌ يا درماتيت‌ سبورئيك‌

پيشگيري‌

اگر چشمتان‌ زياد شالازيون‌ مي‌زند، پلك‌ خود را روزانه‌ با آب‌ و شامپو بچه‌ كه‌ با چيزي‌ شبيه‌ گوش‌ پاك‌ كن‌ ماليده‌ مي‌شود، بشوييد.
با بروز اولين‌ علايم‌ آزردگي‌ چشم‌، روزانه‌ چند بار كمپرس‌ آب‌ گرم‌ روي‌ چشم‌ خود بگذاريد.

عواقب‌ مورد انتظار

شالازيون‌ ممكن‌ است‌ خود به‌ خود بهبود يابد. اگر اين‌ اتفاق‌ نيافتاد، معمولاً مي‌توان‌ آن‌ را به‌ راحتي‌ با جراحي‌ برداشت‌.

عوارض‌ احتمالي‌

انتظار نمي‌رود عارضه‌اي‌ به‌ وجود آيد.

درمان‌

اصول‌ كلي‌

از حوله‌ آب‌ گرم‌ براي‌ كاهش‌ التهاب‌ و تسريع‌ بهبودي‌ استفاده‌ كنيد. حوله‌ را 20 دقيقه‌ روي‌ چشم‌ بگذاريد و بعد حداقل‌ يك‌ ساعت‌ صبر كنيد. اين‌ كار را مي‌توان‌ تا هر زمان‌ كه‌ نياز باشد تكرار كنيد.
اگر شالازيون‌ خود به‌ خود در عرض‌ 6 هفته‌ خوب‌ نشود، برداشتن‌ آن‌ با جراحي‌ در مطب‌ چشم‌ پزشك‌ و تحت‌ بي‌حسي‌ موضعي‌ قابل‌ توصيه‌ است‌.

داروها

امكان‌ دارد كرم‌ها يا پمادهاي‌ آنتي‌بيوتيكي‌ چشمي‌، مثل‌ اريترومايسين‌ يا باسيتراسين‌ تجويز شوند. لايه‌ نازكي‌ از كرم‌ يا پماد را 4-3 بار در روز به‌ لبه‌ پلك‌ بماليد. ماليدن‌ مقدار زيادي‌ از دارو، بي‌خودي‌ آن‌ را هدر مي‌دهد و مؤثرتر از ماليدن‌ مقدار كم‌ دارو نيست‌.
قطره‌هاي‌ آنتي‌بيوتيكي‌ چشمي‌ براي‌ پيشگيري‌ از گسترش‌ عفونت‌ به‌ ساير بخش‌هاي‌ چشم‌. معمولاً نيازي‌ به‌ آنتي‌بيوتيك‌ خوراكي‌ يا تزريقي‌ نيست‌.

فعاليت‌

محدوديتي‌ براي‌ آن‌ وجود ندارد.

رژيم‌ غذايي‌

رژيم‌ خاصي‌ توصيه‌ نمي‌شود.

در اين‌ شرايط‌ به‌ پزشك‌ خود مراجعه‌ نماييد

• اگر شما يا يكي‌ از اعضاي‌ خانواده‌ تان علايم‌ شالازيون‌ را داريد و اين‌ علايم‌ بيش‌ از دو هفته‌ طول‌ كشيده‌اند.
• اگر درد چشم‌ رخ‌ دهد.
• اگر بينايي‌ تغيير يابد.
• اگر دچار علايم‌ جديد وغيرقابل كنترل شده ايد‌. داروهاي‌ مورد استفاده‌ در درمان‌ ممكن‌ است‌ عوارض‌ جانبي‌ به‌ همراه‌ داشته‌ باشند.

Reference:

• doctorirani.org
• en.wikipedia.org/wiki/Chalazion
• my.clevelandclinic.org/health/diseases/17657-chalazion
• medicalnewstoday.com/articles/324215#chalazion-vs-stye
• merckmanuals.com/professional/eye-disorders/eyelid-and-lacrimal-disorders/chalazion-and-hordeolum-stye

See also:

Chalazion Surgery: What You Need to Know

Removal of a Meibomian Cyst (Chalazion)

بلفاریت‌ عبارت‌ است‌ از التهاب‌ لبه‌ پلک‌های‌ چشم‌. امکان‌ دارد التهاب‌ در خود پلک‌ها، مژه‌ها، غدد میبومین‌ meibomian gland (غددی‌ که‌ ترشحات‌ آنها پلک‌ را می‌پوشاند و حرکت‌ آن‌ را تسهیل‌ می‌کند) و ملتحمه‌ چشم‌ (روی‌ سفیدی‌ چشم‌) نیز گسترش‌ یابد.

پلک‌آماس یا بلفاریت (به انگلیسی: Blepharitis ) التهاب پلک‌ها به ویژه در لبه آنهاست. این بیماری شایع بوده و ممکن است بر اثر یک عفونت خفیف میکروبی یا بیماری پوستی منتشر ایجاد شود.

بلفاریت به دو شکل رخ می‌دهد: بلفاریت قدامی و بلفاریت خلفی. در بلفاریت قدامی قسمت جلویی و خارجی پلک که محل اتصال مژه هاست درگیر می‌شود.

دو علت شایع بلفاریت قدامی عفونت‌های میکروبی (مانند استافیلوکوک) و سبوره هستند. در بلفاریت خلفی که ناشی از مشکلات غدد چربی پلک (غدد meibomian) است قسمت داخلی پلک گرفتار می‌شود.

Anterior blepharitis is commonly caused by bacteria (staphylococcus) or oily build-up (seborrhea) associated with skin conditions like rosacea. Posterior blepharitis can worsen dry eye and lead to painful eyelid styes.

دو بیماری پوستی شایعی که سبب بلفاریت خلفی می‌شوند عبارتند از: آکنه روزاسه و شوره سر.[4]

Some research links blepharitis (inflammation of your eyelid) to not having enough vitamin D in your diet. Certain fatty acid supplements may help treat symptoms of blepharitis.

Blepharitis is the medical name for an inflamed eyelid. It usually occurs when you have too much bacteria near the base of your eyelashes.[5]

Blepharitis Symptoms [3]

The main symptom of blepharitis is a red, itchy, and swollen eyelid.

The condition can also cause other symptoms, including:

• Crusty dandruff-like flakes on your eyelashes
• Feeling like there is something in your eyes
• Watery eyes
• Tears that are foamy or have small bubbles in them
• Dry eyes
• Sensitivity to light

Blepharitis can also cause more serious problems like:

• Blurry vision
• Eyelashes that fall out
• Eyelashes that grow in the wrong direction
• Swelling of other parts of the eye, like the cornea, the clear outer layer at the front of the eye

علایم‌ شایع‌

• قرمزی‌ و وجود پوسته‌های‌ روغنی‌ روی‌ لبه‌ پلک‌
• ریختن‌ مژه‌ها
• وجود زخم‌های‌ کوچک‌ روی‌ پلک‌. اگر لبه‌ پلک‌ زخم‌ شود، روی‌ این‌ زخم‌ها دلمه‌ بسته‌ خواهد شد. اگر این‌ دلمه‌ها برداشته‌ شوند، خونریزی‌ رخ‌ خواهد داد.
• تحریک‌ و اذیت‌ شدن‌ چشم‌ در صورتی‌ که‌ پوسته‌های‌ لبه‌ پلک‌ به‌ درون‌ چشم‌ بیافتند.
• احساس‌ اینکه‌ چیزی‌ در چشم‌ وجود دارد. در این‌ حالت‌ چشم‌ دچار خارش‌، سوزش‌، قرمزی‌، تورم‌ پلک‌، حساسیت‌ به‌ نور زیاد، و اشک‌ریزش‌ می‌شود.
• خارج‌ شدن‌ ترشح‌ از پلک‌ها، که‌ باعث‌ به‌ هم‌ چسبیدن‌ مژه‌ها در هنگام‌ خواب‌ می‌شود.
• حساسیت‌ به‌ نور

علل‌

• عفونت‌ باکتریایی‌، معمولاً استافیلوککی‌، در فولیکول‌های‌ مژه‌ها و غدد میبومین‌
• واکنش‌ آلرژیک‌ (تنها در مواردی‌ که‌ التهاب‌ زیاد جدی‌ نیست‌).
• شپش‌ بدن‌ (نادر است‌).

عوامل‌ افزایش‌دهنده‌ خطر

• سن‌ بیش‌ از 60 سال‌
• سابقه‌ درماتیت‌ سبورئیک‌ روی‌ پوست‌ سر و سایر نقاط‌ بدن‌
• مواجهه‌ با مواد شیمیایی‌ یا سایر مواد تحریک‌زای‌ محیطی‌
• زندگی‌ در یک‌ خانه‌ پر جمعیت‌ یا در شرایط‌ بد بهداشتی‌
• تغذیه‌ نامناسب‌
• سرکوب‌ ایمنی‌ به‌ دلیل‌ بیماری‌ یا دارو
• دیابت‌ شیرین‌ (مرض‌ قند)
• آکنه‌ روزاسه‌

پیشگیری‌ eResearch by Navid Ajamin -- winter 2010

• دستان‌ خود را مرتب‌ بشویید و با حوله‌ تمیز خشک‌ کنید.
• از بودن‌ در محیط‌هایی‌ که‌ دارای‌ گرد و غبار یا سایر مواد تحریک‌زا هستند خودداری‌ کنید.
• از مواد آرایشی‌ که‌ خاصیت‌ آلرژی‌زایی‌ کمی‌ دارند استفاده‌ کنید.
• سبوره‌ پوست‌ سر را با شامپوهای‌ حاوی‌ دارو کنترل‌ کنید.

عواقب‌ مورد انتظار

• امکان‌ دارد بلفاریت‌، مقاومت‌ سرسختانه‌ای‌ به‌ درمان‌ نشان‌ دهد، اما گاهی‌ در عرض‌ 12-8 ماه‌ معالجه‌ می‌شود. البته‌ عود آن‌ شایع‌ است‌.

عوارض‌ احتمالی‌

• از دست‌ دادن‌ مژه‌ها
• زخم‌ شدن‌ قرنیه‌ (چشم‌ها را باید پوشاند)
• تشکیل‌ جوشگاه‌ روی‌ پلک‌
• گل‌ مژه‌
• رشد مژه‌ها در جهت‌ غیرطبیعی‌

درمان‌

Self-care measures, such as washing your eyes and using warm compresses, may be the only treatment necessary for most cases of blepharitis. If that is not enough, your doctor may suggest prescription treatments, including:

• Medications that fight infection. Antibiotics applied to the eyelid have been shown to provide relief of symptoms and resolve bacterial infection of the eyelids. These are available in a variety of forms, including eyedrops, creams and ointments. If you don't respond to topical antibiotics, your doctor may suggest an oral antibiotic.
• Medications to control inflammation. Steroid eyedrops or ointments may help control inflammation. Your doctor may prescribe both antibiotic and anti-inflammatory drugs.
• Medications that affect the immune system. Topical cyclosporine (Restasis) is a calcineurin inhibitor that has been shown to offer relief of some signs and symptoms of blepharitis.
• Treatments for underlying conditions. Blepharitis caused by seborrheic dermatitis, rosacea or other diseases may be controlled by treating the underlying disease.[2]

اصول‌ کلی‌

• از پارچه‌ یا حوله‌ آب‌ گرم‌ برای‌ کاهش‌ التهاب‌ و تسریع‌ بهبودی‌ استفاده‌ کنید. پارچه‌ یا حوله‌ را حدود 20 دقیقه‌ روی‌ چشم‌ بگذارید، و بعد حداقل‌ یک‌ ساعت‌ به‌ چشم‌ خود استراحت‌ بدهید. به‌ هر تعداد دفعه‌ که‌ لازم‌ است‌ این‌ کار را تکرار کنید.
• پوسته‌ها را به‌ طور روزانه‌ از روی‌ پلک‌ بردارید.
• از مصرف‌ مواد آرایشی‌ چشمی‌ تا زمانی‌ که‌ التهاب‌ رفع‌ نشده‌ است‌ خودداری‌ کنید.
• تا زمانی‌ که‌ بیماری‌ به‌ طور کامل‌ درمان‌ نشده‌ است‌ از استفاده‌ از لنزهای‌ تماسی‌ نرم‌ خودداری‌ کنید.

داروها

• پماد یا قطره‌ آنتی‌بیوتیکی‌، که‌ امکان‌ دارد حاوی‌ داروهای‌ کورتیزونی‌ نیز باشد.
• در موارد شدید، مثلاً زمانی‌ که‌ آکنه‌ روزاسه‌ نیز وجود دارد، امکان‌ دارد داروی‌ خوراکی‌ نیز تجویز شود.

فعالیت‌

• هیچ‌ محدودیتی‌ برای‌ آن‌ وجود ندارد.

رژیم‌ غذایی‌

• هیچ‌ رژیم‌ غذایی‌ خاصی‌ توصیه‌ نمی‌شود.

در این‌ شرایط‌ به‌ پزشک‌ خود مراجعه‌ نمایید

• اگر شما یا یکی‌ از اعضای‌ خانواده‌ تان علایم‌ بلفاریت‌ را دارید.
• اگر در چشم‌ خود درد احساس‌ می‌کنید.
• اگر بینایی‌ شما تغییر کرده‌ است‌.
• اگر دچارعلایم‌ جدید و غیرقابل کنترل شده اید‌. داروهای‌ مورد استفاده‌ در درمان‌ ممکن‌ است‌ عوارض‌ جانبی‌ به‌ همراه‌ داشته‌ باشند.[1]

انواع بلفاریت چشم و روش های درمان [4]

بلفاریت عفونی

• استفاده از آنتی‌بیوتیک‌های موضعی
• استفاده از کاهش دهنده‌های التهابی (مانند استروئیدها) در موارد شدید
• پاکسازی بستر بلفاریت با استفاده از پارژ بعد از نرم کردن قطرات چشمی و خشک کنی
• پاکسازی و ماساژ محلول سالین برای بلفاریت کاهشی، زمانی که بلفاریت به دلیل انسداد غده‌های چربی اتفاق می‌افتد

بلفاریت التهابی

• استفاده از کاهش دهنده‌های التهابی مانند استروئیدها
• استفاده از آنتی‌بیوتیک‌های موضعی در صورت وجود عفونت همزمان
• استفاده از سردسیری برای تسکین التهاب و خارش
• استفاده از ماساژ چشم برای تخلیه غدد چربی و از بین بردن توده‌های چربی

بلفاریت دماتیسه

• رعایت بهداشت خاکستری چشم و استفاده از آب نمک در تمیزی چشم
• استفاده از قطرات چشمی ضد التهاب و خشکی
• استفاده از کاهش دهنده‌های التهابی در صورت شدت بیماری

بلفاریت روماتولوژیک

• درمان بیماری اصلی با استفاده از داروهای ضد التهاب و مهارکننده بیماری
• استفاده از کاهش دهنده‌های التهابی برای کنترل بلفاریت

Reference:

1. irteb.com
2. mayoclinic.org/diseases-conditions/blepharitis
3. verywellhealth.com/blepharitis-5201907
4. fa.wikipedia.org/wiki/بلفاریت
5. healthline.com/health/eyelid-disorders/blepharitis-vitamin-deficiency