Eye Lid Redness

By Kristin Biggee, MD

Redness of the eyelids is usually a sign of inflammation and/or irritation in this area and is often cosmetically unappealing. When it is located along the margin where the eye lashes exit, it is often a sign of a condition called blepharitis. Blepharitis can be caused by clogging of the oil glands or from a scaly discharge that develops on the eyelid margin. Along with redness, it can also cause tearing, itching, burning, and/or blurred vision.

A good starting treatment for blepharitis is warm compresses over the eye(s) for 3-5 minutes at a time. A clean washcloth run under hot water works well. Some patients also use hot tea bags to place over the eye. Just make sure it's not too hot to avoid burning the skin. Warm compresses help to open the oil glands and decrease inflammation.

Good lid hygiene is also recommended. For this, drape a warm washcloth over your finger and massage along the eyelid margin for at least 30 seconds. This helps to clean off any scaly discharge. Some patients also use baby shampoo on the warm washcloth to aid in the cleansing. This should be done at least twice daily and can be performed after the warm compress. Lubricating drops and/or ointments are also recommended for any associated eye discomfort. A good starting dose is four times daily as needed for eye itching or irritation and can be purchased over the counter. If the above measures do not improve symptoms, an evaluation with an ophthalmologist is recommended to determine if further treatment is indicated.

Some patients with underlying blepharitis go on to develop styes or chalazia. These are red bumps that can develop on the upper or lower eyelids. They occur when a clogged oil gland becomes enlarged and inflammed. They can be associated with eyelid swelling and worsening irritation. Warm compresses and lid hygiene are also recommended in these cases, as styes often resolve on their own with this treatment.

If the bump persists or becomes larger, then other treatments include antibiotic ointments, a steroid injection into the lesion or surgical excision. A steroid injection is often helpful for smaller sized styes. It is a very safe procedure, although there is a small risk of lightening of the skin pigmentation at the injection site. Surgical excision is also a very safe procedure that is routinely performed in the office setting. Complications from this procedure are rare, but include infection, scarring, bleeding, and/or recurrence of the stye.

Finally, if any eyelid redness spreads to involve the entire eyelid or begins spreading to the face, it is very important to have an evaluation with an ophthalmologist promptly. This can be a sign of an eyelid cellulitis (skin infection) that needs to be treated with an oral antibiotic. It also needs to be followed closely, since in rare cases this infection can spread to the eye socket or eye. If the infection is not improving, some patients require intravenous antibiotics. Eyelid cellulitis can be caused by styes or chalazia, but it also has a variety of causes including sinusitis, insect bites, and trauma.

See your ophthalmologist if treatment is needed.