Itching of the eyelids is a common sensation that we all experience from time to time. It may arise with a host of conditions and not all of these are a medical problems. For example, we tend to rub and even scratch the eyelids when we are sleepy and sometimes when we are trying to remember information. However, there are instances where itchy eyelids may be due to a problem with the skin of the eyelid or the inner lining (eyelid conjunctiva), the outer lining of the eyeball (eye conjunctiva), the cornea and with various tear gland and duct problems.
Eyestrain is one of the leading causes of acute itchy eyelids. It is more common these days due to prolonged use of computer screens, mobile devices and with reading in poor light. Irritation, injury, infections and allergic reactions of the eyelids are other causes of itchy eyelids and may arise for a host of different reasons.
Picture 1. Stye (hordeolum)
(source: Samuel Freire da Silva, MD, Atlasdermatologico)
A stye (Lat. hordeolum = barleycorn) is a red, tender, painful, or itchy red bump, resembling a pimple, occurring on the eyelash. It represents an infection (usually by bacterium Staphylococcus aureus) of an oil gland attached to the hair follicle. In children, it mostly occurs due to bad eye or hands hygiene and eye rubbing; in women it may be due to sharing makeup. A stye usually heals on its own in 1-2 weeks. Warm wet compresses applied for 1o minutes 2-3 times a day may help in draining pus and relieving pain. A stye should not be rubbed or squeezed. Topical ointments are usually ineffective (1). Rarely, a surgical incision and drainage is needed.
Picture 2. Chalazion
A chalazion (Gk. chalazion = small lump) appears as a red, non-tender lump on the eyelid. It represents a non-infectious inflammation of the eyelid soft tissue, due to fats squeezed from the obstructed meibomian (oil) glands. Warm compresses soften thick fats thus helping in drainage. If a chalazion is big or it does not clear in several weeks, an injection of steroids or a surgical incision may be performed (1).
Picture 3. Conjunctivitis
Conjunctivitis is the inflammation of the thin transparent lining that lies over the inner eyelid and sclera (whites) of the eyes. The condition is marked by severe redness of the eyes in addition to itching and excessive tearing. It is a common eye and eyelid condition. Conjunctivitis may arise with injury to the eye, infections and allergies. Viral conjunctivitis, also known as pink eye, is one of the more common causes of outbreaks of acute conjunctivitis. Allergic conjunctivitis is often chronic in nature and associated with conditions like allergic rhinitis (hay fever). A less common type of conjunctivitis is known as giant papillary conjunctivitis where irritation and an allergic reaction arise with long term contact lens use.
Blepharitis (Greek blepharon = eyelid) is an inflammation of the eyelid, appearing as reddened, swollen, itchy, and burning eyelid margin. Scaling, pustules, crusts or ulcers may appear. Acute blepharitis may be caused by Herpes simplex or Herpes zoster (varicella) virus, bacterium Stapylococcus aureus, or allergy. Chronic blepharitis may be associated with seborrheic dermatitis, acne rosacea, lice or allergies.
Therapy. Viral infections are treated with antiviral drugs by mouth, and bacterial infections by antibacterial ointments. In marked swelling or allergy, topical corticosteroids may be used (2).
Skin and Eye Allergies
Apart from allergic conjunctivitis, itchy, red and severely swollen eyelids are common symptom in hair dye allergies, nail polish allergy, or make-up allergy. Treatment is by oral antihistamines and oral or topical corticosteroids. Local antihistamines should be avoided, since these substances could trigger allergy. Topical corticosteroids should be also avoided, since prolonged use may thin the eyelid skin. Overall avoidance of the known allergen (trigger of the allergy) is the main way to manage these types of allergies.
Seborrheic keratosis (Greek sebum = oil; rhein = flow; keratosis = thickening of corneal skin layer) is an itchy, pigmented, greasy outgrowth from the eyelid, occurring mostly in old people. These lesions are more commonly seen on he body. It can be removed surgically but there is a chance of recurrence.
Picture of Seborrheic Keratosis
Picture 4. Actinic keratosis
(source: Samuel Freire da Silva, MD, Atlasdermatologico)
Actinic (Gk. aktis = ray) keratosis is a flat, whitish, shiny, or reddish, purplish, brown, or black, slightly raised lesion appearing on the sun exposed skin, caused by ultraviolet light. It can be precancerous. This means that it may develop into a cancer, so it has to be removed.
Additional Pictures of Solar Keratosis (search for “keratosis solar”)
Picture 5. Eyelid wart (papilloma)
Warts, caused by Papilloma virus can appear on the eyelid. They may be threadlike or flat, skin-colored, yellow, or brown. They may occasionally itch. In general they do not cause any problems. If warts pose a problem then they may be surgically removed. It should not be confused with a skin tag, which is also known as an acrochordon.
Basal Cell, Squamous Cell, and Sebaceus Gland Carcinoma
Basal cell carcinoma usually appears on the lower eyelid as a pearl-like hard nodule, often covered by tinny vessels or with ulceration in the middle. Squamous cell carcinoma usually appears on the upper eyelid. Sebaceus gland carcinoma may mimic a chalazion. Treatment is with a complete surgical removal.
Head and Pubic Lice
Head or pubic lice can be sometimes found on the eyelashes. It may descend from the scalp or some other area where it hides to then feed off blood from the eyelids. This feeding then causes irritation of the affected area which may manifest as itching.
Human Demodex mites, which tend to live in hair follicles and oil (sebaceus) glands of the eyelashes or eyebrows, may cause eyelid itching and scaling, dry or red eyes.
Eye problems and diseases, like eyestrain, keratitis or trachoma, also cause eyelid itch. It is usually accompanied by other symptoms like redness of the eyes, blurred vision and excessive tearing or dryness of the eyes. These conditions need to be considered and treated respectively.
- Itch – Diagnosis, Prevention, and Treatment
- Causes of Itchy Skin
- Itchy Legs
- Itchy Feet and Toes
- Itchy Arms and Hands
- Stye and chalazion treatment (merck.com)
- Blepharitis treatment (merck.com)
- Seborrheic keratosis (aafp.org)