Entropion refers to an eye condition in which the eyelid turns inwards, resulting in the rubbing of the eyelashes and skin against the surface of the eye. This often causes every day discomfort and irritation, and many people suffering from the condition will seek eyelid surgery to help relieve symptoms.
Here, we discuss the causes and symptoms of entropion, as well as how it can typically be treated.
Entropion is a condition in which a person’s eyelid folds inward. In most cases, this only affects the lower lid, and will cause the eyelashes to rub against the cornea, causing irritation, itching and soreness. People with entropion may find that their eyelid is turned inwards all the time, or it may only happen when they blink or squeeze the eyes closed.
Entropion is a condition which mostly affects adults, and it can be caused by several factors:
• Weakening of the eye muscles – This is the most common cause and occurs as a result of old age. As we begin to age, our under-eye muscles will weaken, stretching the tendons further out and loosening the ligaments and muscles. Around 2% of the elderly population experiences involutional (age-related) entropion.
• Scarring – skin around the eye which is scarred by surgery or eye trauma can result in a distorted eyelid curve.
• Inflammation – an eye irritation, caused by inflammation or dryness, can result in a person rubbing their eyelids or trying to squeeze them shut in an attempt to relieve symptoms. This may then lead to a spasm of the muscles, which causes the rolling of the eyelid inwards. This is known as spastic entropion.
• Congenital – This is where the condition is present at birth. In some cases, there may be an extra fold of skin on the eyelid which can result in inward-facing eyelashes.
• Eye infection – Eye infections, known as trachoma, are common in many developing countries and can result in scarring of the eyelid and then entropion.
There are, therefore, several factors that increase a person’s chances of developing entropion, including age, previous eye surgery or trauma, and trachoma infection.
Entropion causes the eyelid to turn inwards, which means the eyelashes can rub on the eye’s surface. As such, a person may feel like there is something in the eye, as well as several other symptoms, including:
• Irritation, soreness or pain
• Watery eye (excessive tearing)
• Eyelid crusting
• Blurry vision
• Light sensitivity
In most cases, an optician or ophthalmologist can diagnose entropion through a routine eye examine. During diagnosis, they may pull on the patient’s eyelids and ask the patient to blink or squeeze their eyes shut, which helps them to determine the eyelid’s position on the eye, as well as the muscle tone and tightness.
If the condition is a result of scar tissue from a previous surgery or trauma, the surrounding eye tissue may also be examined.
If entropion is left untreated, it can cause great sensitivity and irritation, as well as scratches and infections of the ocular surface. This can, in turn, pose a potential threat to eyesight. As such, it is extremely important to seek appropriate treatment before it can result in permanent damage to the eye.
There are several treatment options available for those with entropion and the approach taking will depend upon the cause and seriousness.
Non-surgical treatment options exist to help relieve the symptoms and prevent further damage to the eye area. A common temporary treatment type which helps relieve symptoms is the taping of the eyelid. Here, the skin around the eye is cleaned and dried. Then, a strip of medical tape is applied under the edge of the eyelid, towards the cheek. The aim of taping is to hold the eyelid in its normal position. It should be kept in place and left untouched and should not be secured so tightly that the patient cannot close their eyes normally (i.e. without squeezing them).
Sometimes, an injection of BoNT may be used to help weaken the muscle which is causing the eyelid to turn inwards. This can be highly effective and is normally carried out prior to having surgery. These injections can also be used as an alternative to surgery, although the need to be repeated every 3 months or so. Artificial tears and lubricants are sometimes used to help lessen symptoms.
In many cases, surgery is the best treatment option. An entropion procedure is normally carried out by an eyelid surgeon, as a day case and using local anaesthetic. Patients will, therefore, be awake during the procedure, but an injection will be used to numb the eyelid so that they cannot feel pain. Eye drops will help ease the discomfort and prevent the eye from drying. The procedure takes around 45 minutes per eyelid, though patients can expect to spend about half a day in hospital, including preparation and aftercare.
On the day of the surgery, the patient will be able to eat and drink as normal. Medication is also allowed, though Aspirin and other anticoagulants should not be taken for 14 days prior to the operation. If you are unsure, speak to your doctor for advice.
The aim of surgery is to reposition the eyelid to a normal resting position. This involves the tightening and repositioning of the outer eyelid tissues, as well as the placing of stitches to help prevent the eyelid from turning inwards. Stitches will also close the wound, and a pad will be placed over the eye.
For the majority of patients, surgery will fix the issue almost immediately, though there will be some short-term discomfort. Once the eyelids have healed, the patient’s eye will feel much more comfortable and there should no longer be a risk of scarring, infections or vision loss.
Following the procedure, bruising and swelling is completely normal around the area operated on. This will typically subside within 1-2 weeks. Scars are kept to a minimum, as surgeons will try to place the incision on the patient’s natural eye crease.
Patients are advised against driving home from the hospital after the surgery, so it is best to pre-arrange transport or have a chaperone. This is because the patch placed over the eye obstructs vision.
The eye pad can normally be taken off the day after the procedure. Patients should wash their hands thoroughly before removing the pad. The eyes can be gently bathed using a gauze and saline solution provided at the hospital before being discharged. The stitches are normally taken out as an outpatient procedure around two weeks after the surgery.
Infections and bleeding are uncommon, but are risks that can occur after any surgical procedure. Likewise, it is unlikely that the condition can reoccur, but this is still a risk nonetheless. In which case, another surgical procedure may be necessary.