The eyelid is more than a cover. It protects the ocular surface, spreads the tear film across the cornea with every blink, and pumps excess tears towards the drainage system. When the shape, position or movement of the lid is disturbed, all three functions fail at once: the surface dries, becomes irritated and is left open to infection.
In children these disorders may be congenital or may follow trauma, infection or a mass. Parents usually notice the difference in appearance first; my priority question is whether the lid can still protect the cornea and whether the visual axis is clear.
Related topics include eyelid infections in children, eyelid vascular masses and congenital masses and cysts. For the adult conditions see entropion and ectropion. All topics are listed under pediatric eye diseases.
As an Ophthalmologist, Dr. Ayşe Dolar Bilge, I provide diagnosis and treatment services with my experienced team.
The commonest cause in children is epiblepharon, an extra fold of skin and muscle at the lower lid margin that pushes the lashes upright. In many children it improves as the face grows. Observation is enough when the cornea is intact and symptoms are mild; surgery is used when there is persistent light sensitivity, blinking and damage to the corneal surface.
No. An epicanthal fold is a fold of skin at the inner corner that covers part of the white of the eye and can make perfectly aligned eyes look crossed; this is pseudostrabismus. The distinction is made at examination by checking whether the corneal light reflex falls symmetrically in both eyes.
Yes, in two ways. If the lid covers the visual axis, no sharp image reaches the retina and amblyopia develops. If the lid presses on the cornea, astigmatism is induced and the outcome can be the same. For that reason every child with a lid problem has a vision assessment and cycloplegic refraction.
Incisions are placed in the natural creases and, because eyelid skin is thin, scars usually remain faint. Full maturation takes months, during which colour and firmness change, so the early appearance should not be taken as the final result.
When the lids do not close, the lower cornea dries and surface damage can develop over time, so night ointment is used to protect it. The underlying cause may be a short lid, a coloboma, scar tissue or previous surgery, and an examination is needed to identify it.
The large majority of eyelid lumps in children are benign, most often haemangiomas and dermoid cysts. Even so, a lump that grows quickly, changes colour, bleeds, causes loss of lashes or distorts the lid margin should be assessed. Examination and, where needed, imaging make the distinction.
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