Close up of involutional entropion of the lower eyelid during eye examination.
Entropion: Causes and Treatment Options
This article discusses the symptoms, causes, and treatment options related to entropion.
Entropion is the retraction of the bottom or top eyelid toward the eyeball. It causes irritation and discomfort in the affected eye.
However, entropion is more than an uncomfortable inconvenience. It can cause long-term eye damage without treatment. This may involve surgery to correct the eyelid’s position.
Entropion is the opposite of ectropion, which occurs when an eyelid is drooping away from an eye. These conditions have similar causes, including aging and scarring.
This is a summary of the four types of entropion.
- Involutional entropion: This is the most common type. It is characterized by the relaxation of the tendons and the weakening of the muscles. The position of the eyelid changes and folds inward. Increasing age is a common cause, but there are other causes.
- Spastic entropion: This is similar to involutional entropion in that the eyelid changes position. It is not due to aging, however. Irritation, infection, previous surgery, and other causes can contribute.
- Cicatricial entropion: This type is due to chronic inflammation from other conditions or surgery. This can cause scarring and shorten the strong tissues lining the eyelid.
- Congenital entropion: This is a rare type of entropion wherein the lower eyelid is folded inward at birth.
Common symptoms include:
- one or more inwardly turned eyelids
- eye redness and irritation
- foreign object sensation in the affected eye
- eye discomfort and pain
- excessive tears
The symptoms of entropion may be mild at the onset, but they usually worsen.
Treatment options for entropion include nonsurgical and surgical techniques.
Entropion treatment varies, but surgical repair is a viable option for all types of entropion. One option is the Quickert suture technique.
With this technique, the surgeon places sutures through the eyelid so that they exit the tissue at the eyelashes. This tightens the muscles in the eyelid. The operation takes about 30 minutes per eye and requires a local anesthetic.
If suture techniques do not correct entropion, the surgeon may need to perform a lid shortening procedure. One option is to make an incision into the lid, remove any excess tissue, and then close the tissues. Another option is the lateral tarsal strip procedure, in which the eyelid is shortened and then anchored to the orbit on the side of the eye.
If your doctor recommends surgery, discuss the specific options and the benefits and typical outcomes of each.
Treating an underlying cause, such as an infection or inflammation, will increase the chance of a favorable outcome with surgery.
Treatments such as eye taping or eye drop lubricants may ease the symptoms. Therapeutic contact lenses may also be an option to protect the cornea.
After receiving surgical treatment, recurrence is possible but rare.
In one study using a combined procedure — sutures with the reattachment of the eyelid muscles to the tarsus, which is the strong connective tissue that gives structure to the eyelid — entropion recurred in 1 of 28 eyes after 2 years.
The researchers note that previous studies of sutures alone showed a recurrence rate of 15% over a mean follow-up period of 31 months.
With entropion, the bottom or top eyelid is positioned inward, toward the eyeball.
photo by ARZTSAMUI/Getty Images
Lower eye lid entropion and trichiasis (eyelashes growing inwards) in a person of Asian descent.
Yelena S. Kim/Shutterstock
Entropion of upper eyelid
Entropion is usually the result of age-related muscle changes. Other causes include:
- muscle spasms in the eyelid (blepharospasms)
- previous surgeries
- chemical burns
- trachoma bacterial infections
- scar tissue
- congenital anomalies
- chronic inflammation, as in ocular cicatricial pemphigoid
Ocular cicatricial pemphigoid causes scarring and shortening of the conjunctiva, which lines the eyes and eyelids.
An eye specialist may diagnose entropion by symptoms and the appearance of the eyelid. They use a microscope to closely examine the eye and eyelids.
However, you may also need to visit an ophthalmologist for additional workup and testing. This is a physician who specializes in the diagnosis and treatment, including surgery, of conditions affecting the eye and associated structures.
The American Academy of Ophthalmology says that the doctor should take note of any:
- eyelid or facial spasms
- signs of irritation or infection of the skin and eye surface
- scarring of the conjunctiva and inner eyelid surface
- scarring or thinning of the cornea
- swelling, discoloration, pain, and other signs of inflammation
Your eye doctor may also evaluate the strength of the lower lid with a so-called snap-back test. This involves gently pulling the lower lid down while noting how well or if the lid returns to its original position. The lid may not return to its position until you blink.
To evaluate the possibility of eye spasms causing entropion, your doctor may apply a topical anesthetic and forcefully close your eyelids while you look down. If uncontrollable eye movements and blinking continue, spasms may be causing entropion.
Because your eyelids protect your eye and provide lubrication, entropion can expose your eye and increase the chance of damage. Without treatment, entropion may lead to:
- permanent cornea damage
- frequent infections, such as pink eye
- excessive eye swelling
- eye injury
Here are some other questions that people ask about entropion.
How is entropion treated without surgery?
If you are not a candidate for surgery, Botox injections may be an option. Eye taping, eye drops, and therapeutic contact lenses may increase comfort and help reduce the chances of injury and infection.
What happens if you do not treat entropion?
Delaying or avoiding treatment for entropion can increase the chance of eye injury, infection, and irritation.
Surgery for congenital entropion may be necessary to correct the issue. Your pediatrician may suggest delaying treatment to see if the condition resolves on its own.
How can you fix entropion?
Surgery is the definitive treatment for entropion.
Entropion occurs when an eyelid curls inward toward the eye. Causes include aging, infections, and injuries.
Surgical techniques that strengthen and support the eyelid may resolve the issue in adults. Entropion in infants may go away on its own, but surgery may be necessary.