Entropion

What is an entropion of the eyelid?

Entropion is inward turning of the lower eyelid, resulting in the eyelashes directing towards the surface of the eye, causing discomfort.  The skin of the eyelid and the eyelashes may rub against the cornea (front part of the eye) and the conjunctiva (the white mucous membrane that protects the surface of the eye).  Rubbing of the eyelid skin and lashes against the eye can result in excess tearing, crusting of the eyelid, mucous discharge, foreign body sensation, irritation of the cornea and impaired vision from keratitis.

What are the causes of eyelid entropion?

Most commonly entropion is due to relaxation of the tissue in the eyelid as a result of ageing.  It can be caused occasionally by scarring of the inner surface of the eyelid from chemical or thermal burns of inflammatory diseases, such as ocular pemphigoid or allergic reactions.

How is entropion managed?

Temporary relief of entropion can be by taping of the eyelid outwards, putting in comforting lubricant drops, or temporarily paralysing the muscle that turns the eyelid in (orbicularis muscle) with a tiny injection of Botox, or Botulinum Toxin A, to the muscle of the lower lid.  In the long term, surgery is recommended to prevent rubbing damage of the eyelid skin and lashes on the front of the eye, by reducing infection and risk of scarring. 

What type of surgery is done for entropion of the lower eyelid?

Surgery for entropion is usually done under local anaesthesia, as an out-patient.  The oculoplastic surgeon will tighten the eyelid and its attachments, which can be done by either some simple sutures, or stitches, placed through the lower eyelid, or sutures plus eyelid tightening and stabilisation with a lateral tarsal strip.  You may have an eyepad overnight and then will put in antibiotic drops or ointment for one to three weeks.  After the eyelid has healed, the eye should feel comfortable, the eyelid be in a normal position and there will no longer be any risk of corneal scarring, infection or loss of vision.

What are the risks of entropion surgery?

• Bruising around the eyelids and on the eye.
• Infection of the eyelid or eye.
• Recurrence or over-correction of the eyelid, resulting in it turning outwards, requiring further operation.
• Allergic reaction to the local anaesthetic injection,  or the antibiotic ointment or drops.

What are the benefits of entropion surgery?

• Complete relief of symptoms of tearing, crusting, mucous discharge, foreign body sensation, irritation and blurred, impaired vision.  
• Reduction of the risk of eye infection and restoration of the normal position and appearance of the eyelid.