Eyelids, Lacrimal Disease & Exposure
Assess lid lesions and watering while protecting the corneal surface.
Quick revision ↓ Medical Dictionary
01Lid-margin disease
Blepharitis and meibomian gland dysfunction can cause crusting, irritation and tear-film instability. Examine the lid margin and ocular surface, and explain suitable lid hygiene and treatment through local guidance. Symptoms often fluctuate and may need continuing care. Marked pain, corneal change or reduced vision should not be attributed automatically to chronic blepharitis.
02Localised lumps
A hordeolum is usually an acute tender inflammatory or infective lid lesion, whereas a chalazion is a blocked-gland inflammatory nodule that may become less tender over time. Conservative care may be appropriate after assessment. Persistent, atypical or recurrent lesions in the same location need review, especially with lash loss, ulceration or distorted lid architecture.
03Lid position and closure
Entropion turns the lid inward and can allow lashes to rub the cornea; ectropion turns it outward and can impair tear drainage and surface protection. Incomplete closure from facial weakness or other causes exposes the cornea. Assess surface integrity and arrange appropriate protection and referral. Pain or reduced vision indicates possible corneal involvement requiring urgent attention.
04Watering and infection
Epiphora may result from excess reflex tears, drainage obstruction or lid malposition. A painful red swelling near the lacrimal sac suggests dacryocystitis and needs prompt clinical assessment. Fever, spreading swelling or orbital signs increases urgency. Do not treat all watering as a simple blocked duct without checking the surface, lid position and the surrounding tissues.
05Suspicious lesions and continuity
Progressive lid lesions, bleeding, ulceration or loss of lashes warrant an appropriate malignancy pathway. Photographs with consent can support follow-up but do not replace examination. After treatment, provide instructions for surface protection and review. Ensure a patient who cannot close the eye or administer care has practical assistance and a clear escalation route.
High-Yield Revision
- Watering may reflect surface irritation rather than obstruction.
- Lash loss and ulceration are concerning features of a lid lesion.
- Incomplete closure can threaten the cornea.
Common Pitfalls
- Calling every recurrent lid lump a harmless chalazion.
- Ignoring corneal exposure in facial weakness.
References & Further Reading
Read the relevant guideline sections alongside these original clinical teaching cases. Local pathways, available services and individual patient factors determine care.
Reference review: 28 September 2026. Consult current local protocols for prescribing, procedures and escalation.