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Entropion: Causes, Symptoms & Treatment

Entropion is a condition in which the eyelid margin rolls inward, causing the eyelashes to rub against the cornea. It most commonly affects the lower eyelid in older adults.

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Things worth knowing about "Entropion"

Entropion is a condition in which the eyelid margin rolls inward, causing the eyelashes to rub against the cornea. It most commonly affects the lower eyelid in older adults.

What is Entropion?

Entropion is a condition in which the edge of the eyelid turns inward toward the eyeball. As a result, the eyelashes and the skin of the lid come into direct contact with the sensitive cornea and conjunctiva. This causes persistent irritation, discomfort, and, if left untreated, can lead to permanent eye damage. The lower eyelid is most commonly affected. Entropion occurs predominantly in older adults, but can also result from scarring, infections, or congenital factors.

Causes

Entropion is classified into several types based on its underlying cause:

Involutional (age-related) entropion: The most common form. As people age, the muscles and connective tissue of the eyelid weaken, allowing the lid to rotate inward.
Cicatricial entropion: Caused by scarring of the conjunctiva due to injuries, surgery, chemical burns, or chronic inflammatory conditions such as trachoma (a bacterial eye infection).
Spastic entropion: Triggered by spasm of the orbicularis oculi muscle, often associated with ocular irritation or following eye surgery.
Congenital entropion: Rare; present from birth due to a developmental abnormality of the eyelid.

Symptoms

Symptoms of entropion result from the continuous contact of the eyelashes and lid skin with the surface of the eye:

Foreign body sensation or scratching in the eye
Excessive tearing (epiphora)
Redness and irritation of the eye
Sensitivity to light (photophobia)
Blurred vision when the cornea is affected
Pain or burning sensation in the eye
In advanced cases: corneal damage, ulceration, or scarring with permanent vision loss

Diagnosis

Entropion is typically diagnosed through a clinical examination by an ophthalmologist. The following assessments are commonly used:

Inspection: Inward rotation of the eyelid margin is often visible to the naked eye.
Slit-lamp examination: Evaluation of the cornea and conjunctiva for damage caused by eyelash contact.
Eyelid function tests: Assessment of lid tension and mobility to help determine the cause.
Fluorescein staining: Used to identify corneal abrasions or defects.

Treatment

Treatment depends on the underlying cause and severity of the condition:

Conservative Measures

Temporary or preparatory measures may include:

Eye drops or ointments to relieve irritation and protect the cornea
Taping the eyelid to temporarily hold it in the correct position
Botulinum toxin injection for spastic entropion to relax the lid muscle

Surgical Treatment

Surgical correction is the only long-term solution in most cases. Several procedures are available depending on the type and cause of entropion:

Eyelid tightening (lateral tarsal strip or canthoplasty): Used for age-related lid laxity to restore proper lid position.
Tarsal plate procedures: Correction of the eyelid anatomy for lasting stabilization.
Scar release: In cicatricial entropion, scar tissue is released and mucous membrane grafts may be used.

Following surgery, complete resolution of symptoms can generally be expected, provided no permanent corneal damage has occurred.

References

Kanski, J. J., Bowling, B.: Clinical Ophthalmology: A Systematic Approach. 8th edition. Elsevier, Edinburgh, 2016.
American Academy of Ophthalmology (AAO): Entropion - Preferred Practice Pattern. AAO, San Francisco, 2023. Available at: https://www.aao.org
Tyers, A. G., Collin, J. R. O.: Colour Atlas of Ophthalmic Plastic Surgery. 4th edition. Elsevier, Edinburgh, 2017.

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