The redness is conjunctivitis and the blepharospams inidcates an irritative focus somewhere. Have a closer look at the lower lid – can you see some tiny black hairs near the medial canthus? These are distichia, aberrant hairs from the meibomian glands, that needed to be removed, either by epilation, electrolysis, cryosurgery or best of all in my book, by sharp knife removal of the meibomian glands in that area which harbour the hair follicles for the aberrant cilia. Here is a case in which the hairs are much more obvious, caught in the light beam used to illuminate the eye. This shows the need for good light and good magnificationin the diagnosis of the condition.