Entropion of the Eyelids
What is an entropion?
An entropion is an abnormal inward turning of the margin of the eyelid (where the eyelashes are). This can result in rubbing of the eyelashes onto the conjunctiva (white part of eye) and cornea (clear window of the eye in front of the iris). It most commonly affects the LOWER eyelid, but can occasionally affect the upper eyelid.
What causes an entropion?
In most cases, an entropion is seen in the older adult, and is due to aging of the tissues of the eyelid that support and hold it in place. These supporting structures include the tendons at the inner and outer corner of the eyelids (medial and lateral canthal tendons), and the internal muscles of the eyelid (retractors). Stretching or detachment of these supporting structures results in the eyelid either turning inward (entropion) or outward (ectropion –see separate information sheet).
Less commonly, an entropion may develop from scarring of the inner surface of the eyelid from previous trauma, infection or inflammation in the eye. Very rarely, a child may develop an entropion early in life due to maldevelopment of certain eyelid structures.
How do I know I have an entropion?
An entropion usually causes one or more of the following symptoms:
- Irritated painful eye (foreign-body, gritty sensation)
- Watery eye
- Red eye or reddened eyelid margin
- Excess mucous discharge from the eye
These symptoms usually result from the rubbing of the inward turning eyelashes onto the surface of the eye. Sometimes, in addition to the entropion, the eyelashes themselves grow in the wrong inward direction (Trichiasis), and also cause irritation of the eye.
What complications can an entropion cause?
An entropion will not spontaneously correct itself. In many cases, it will continue to worsen, and may cause complications of the eye itself. In particular, traumatic rubbing of the cornea by the eyelashes can result in sight-threatening infections or scarring.
What treatment is available for entropion?
Entropion of the lower or upper eyelids is best managed with surgery. This can be performed as a day case and under local anaesthetic. It usually involves tightening and reattachment of the supporting tendons and retractor muscles, via incisions made in the outer and/or inner corners of the eyelids, and the internal aspect of the eyelid.
Occasionally, sutures are used alone to place the eyelid in the correct position temporarily, until more definitive surgery can take place. If the entropion is due to internal scarring of the eyelid, then grafts of the mucous membrane may be required.
The aim of surgery is to restore the normal position of the eyelid margin with a good cosmetic result, and to achieve a comfortable eye.
If you also have in-turned eyelashes (trichiasis), these can be treated at the same time as the entropion. This may involve electrolysis, cryotherapy (freezing) or excision of eyelash follicles performed under an operating microscope.
As a temporary measure before definitive surgery, the lower eyelid may be taped into the correct position, and artificial tears (drops or ointment) used to protect the surface of the eye.
In situations where surgery is not possible (for example, if the patient is not medically fit for surgery) or not desired by the patient, there are some non-surgical treatment methods. These include the use of cautery or radiofrequency to reposition the eyelid. However, these measures are often temporary, and the recurrence rate of ectropion is higher than with surgery.
What are the risks of entropion surgery?
This surgery is confined to the eyelid tissues, and does not involve the eye itself.
The risks of any anaesthesia used during surgery will be discussed with you by your anaesthetist.
The risks of surgery include (but are not limited to):
- Asymmetry of eyelid position (left and right sides look slightly different in position or contour)
- Suture granuloma (tender lump at outer corner of eyelid which forms in relation to the sutures used, and which may require further surgery to remove)
- Tenderness at the outer corner of the eyelid (which may last a few weeks to months)
- Recurrence of entropion and need for further surgery
What to expect after entropion surgery
Click here for information on Eyelid Surgery.
After surgery, all patients will have bruising and swelling of the lower eyelids which may extend into the cheek or lower face/neck. This usually recovers over 1-2 weeks.
The eyelid often feels and looks tight, and can take up to 6 weeks to soften and settle into its final position, as healing progresses.
There may be tenderness in the outer corner of the eyelid, which can last weeks but usually settles. This is due to the internal sutures used to tighten the outer eyelid.
The eye may feel gritty, irritated or watery in the first few days after surgery, but this usually settles.
You will be reviewed 1-2 weeks and 3 months after surgery, to assess the results.