Entropion

What is entropion?

Entropion is a condition that occurs when your eyelid turns inward toward your eyeball. When this happens, your eyelid skin and eyelashes rub against the surface of your eye. This friction often causes discomfort and irritation to your cornea (front of your eye). Entropion is the opposite of ectropion, the outward turning of your eyelid.

Entropion usually occurs in your lower eyelid, and it can happen on one side or both (bilateral entropion). Without treatment, it can damage your cornea and lead to vision loss. If you’ve developed the condition, it’s important to see an eye care specialist for treatment. Entropion treatment typically starts with noninvasive measures but may require surgery.

Types of entropion

There are several types of entropion that can affect your eyes. These are:

• Involutional. Muscles and tendons in your eyes loosen and weaken as you age, resulting in this most common type of entropion.
• Spastic. Irritation, infection and inflammation can lead to this type. It most commonly occurs after eye surgery in people who had previously unrecognized involutional entropion.
• Cicatricial. Scar tissue formation causes this type of entropion. It may result from burns, infections, inflammation, trauma, eye surgery or radiation therapy.
• Congenital. This means you’ve had the condition since birth.
• Mechanical. The weight of your eyelid is causing it to turn in on itself. This type commonly occurs due to a mass or tumor on your eyelid.

Symptoms of entropion

Entropion causes many uncomfortable symptoms in your eye, including:

• Feeling like there’s something in your eye
• Red eyes
• Tearing (watering)
• Blurry vision
• Eye pain
• Itching
• Sensitivity to light (photophobia) and wind
• Drainage or crusting

When you first develop entropion, you may only notice occasional symptoms. But over time, the symptoms usually become constant.

Entropion causes

There are three characteristics of an eyelid with entropion: eyelid looseness (laxity), eyelid retractor disinsertion and excessively strong eyelid closing muscles which cause your eyelid to turn in rather than out. Lower eyelid laxity is common in people over the age of 60 because their eyelid supports weaken with age. Other causes of an in-turned eyelid include:

• Eye injury
• Infection
• Previous eye surgery
• Inflammatory conditions
• Scarring, due to any of the above

Risk factors for entropion

Aging is the biggest risk factor for entropion. It’s most common in people over 60 years old. According to the American Academy of Ophthalmology, it affects about 2.1% of people over the age of 60.

People with sleep apnea may be at greater risk of developing entropion, as they tend to have excessively loose upper eyelids (floppy eyelid syndrome), which are prone to turning in on themselves.

Entropion also affects people assigned female at birth more often than people assigned male at birth.

How doctors diagnose entropion

Your eye care specialist will start by asking you about your symptoms and medical history. They’ll perform an eye exam, looking for any signs of skin irritation, infection or scarring. They’ll pay close attention to the edges of your eyelid, as there are other medical conditions that can mimic entropion. They want to ensure they make the correct diagnosis to decide the proper treatment.

Tests that are used to diagnose entropion

Your provider may perform several tests to help diagnose entropion. These tests include:

• Snap-back test. Without allowing you to blink, your provider pulls your eyelid down and observes how long it takes to return to its original position.
• Distraction test. Your provider pulls your eyelid away from your eye and measures the distance. They consider more than 6 millimeters abnormal.
• Slit lamp exam. A slit lamp is a special microscope with a bright light that your provider uses to examine your eye, looking for signs of the condition.

How is entropion treated?

Your healthcare provider may treat entropion in several ways. Common entropion treatments include:

• Lubricating eye drops. Lubricating your eye with ointment and artificial tears can provide moisture and relieve discomfort. This isn’t a long-term solution, though.
• Soft contact lenses. Your healthcare provider might recommend wearing soft contact lenses to protect your eyes from irritation. Contact lenses act as a bandage to help ease your symptoms.
• Tape. You can use tape to reposition your eyelid temporarily.
• Stitches. Your provider will numb your eyelid and stitch it into a more favorable position. The resulting scar tissue can also help keep your eyelid turned outward for a few months.
• Botox®. Your provider can use a small amount of botulinum toxin to weaken the eyelid muscles that are causing your lid to turn in.
• Eyelash removal. Epilation is a procedure where your eyelashes are plucked to keep them from irritating the surface of your eye.

If your eyelid is turned in due to chronic inflammation, your provider may order labs or perform a biopsy to investigate rarer causes, like ocular cicatricial pemphigoid or trachoma.

Entropion surgery

The above options may offer a temporary fix, but your healthcare provider will usually have to perform surgery to address the inward-turning eyelid and return it to a normal position. These surgeries typically involve sedation and local anesthesia to numb your eyelid. You’ll go home the same day as your surgery.

Surgical entropion repair methods include:

• Eyelid tightening. This procedure shortens your eyelid (called a wedge resection or lateral tarsal strip) to tighten your lid.
• Retractor reinsertion. This procedure tightens your lid retractor (the muscle that opens and closes your lid).
• Orbicularis debulking. This procedure weakens part of the muscle that’s responsible for closing your eyelids.
• Eyelid margin reconstruction. For trauma or chronic inflammation, electrocautery and/or cryotherapy (freezing) may be used to permanently remove (epilate) misdirected eyelashes.

While nonsurgical treatments are helpful in the short term, entropion surgery is usually necessary to fully and permanently correct the condition.

Most people experience temporary side effects following entropion surgery, including swelling and bruising. These symptoms are a normal part of healing and you can manage them with prescribed medication and cold compresses. In most cases, people fully recover from surgical entropion repair in about two weeks.

When should I see my healthcare provider?

Contact your healthcare provider if your eyelid turns inward. Even if your eyelid doesn’t appear to turn inward, seek medical treatment if you feel like something is constantly in your eye.

What questions should I ask my healthcare provider?

If you have entropion, you may want to ask your healthcare provider:

• What complications should I look out for?
• Is there anything I should avoid during recovery?
• Do I need a follow-up visit? And if so, when?
• What can I do to prevent entropion from returning?

Can I prevent entropion?

Because entropion often occurs naturally with aging or after scarring, it’s difficult to prevent. To reduce your risk of developing entropion caused by injury, wear protective eyewear during activities that could injure your eye.

What can I expect if I have entropion?

Most people who receive treatment for entropion before it causes eye damage have a good outcome. Entropion surgery usually resolves the problem, and the condition rarely returns.

It’s important to treat entropion to avoid complications that may become permanent. Complications associated with an inward-turning eyelid include:

• Eye infections
• Corneal abrasions (scratches)
• Vision loss