Entropion

Entropion (en-TROH-pee-on) is a condition in which an eyelid turns inward. The eyelid and eyelashes then rub against the surface of the eye. This causes discomfort and can damage the outer layer of the eye.

The most common type of entropion affects the lower eyelids of older adults.

Treatment may vary depending on the underlying cause, but surgery is usually needed to correct the condition. In the short term, lubricating ointments, protective contact lenses and other treatments can help relieve symptoms of entropion.

The signs and symptoms of entropion are the result of the eyelashes and outer eyelid rubbing against the surface of your eye:

• A feeling of something in the eye.
• Eye redness.
• Eye discomfort or pain.
• Sensitivity to light and wind.
• Dry eyes.
• Watery eyes.
• Discharge and eyelid crusting.

When to see a doctor

See your healthcare professional if an eyelid is turned inward or an eye is constantly irritated.

Seek immediate care if you experience:

• Pain or achiness in the eye.
• Increased pain with exposure to light.
• Decreased vision.

These symptoms could indicate severe injury to the eye, including injury to the clear outer layer at the center of the eye, called the cornea.

Entropion can be caused by:

• Muscle weakness. With age, the muscles around the eyes tend to weaken, and tendons stretch out. These muscles and tendons typically hold the eyelid snugly against the eye. When the muscles and tendons weaken, the eyelid can roll inward. This is the most common cause of entropion of the lower eyelid.
• Scar tissue. Entropion may be caused by scarring of the inner eyelid from injury, infection, surgery or long-term inflammatory conditions. This type of entropion often affects the upper eyelid.
• Muscle spasms. Entropion may be the result of muscle spasms triggered by irritation of the eye, infection or eye surgery. This type of entropion may come and go.
• Glaucoma medicines. Entropion may be a side effect of long-term use of certain medicines used to treat an optic nerve condition called glaucoma.
• Congenital condition. Rarely, entropion is a condition present at birth, also called a congenital condition.

Factors that increase your risk of developing entropion include:

• Older age.
• Earlier eyelid or eye surgery.
• Earlier eye injury.
• Eye infection, especially a bacterial disease called trachoma.

The rubbing of the eyelashes and eyelid against the eye can damage the cornea and cause vision loss. The damage may include:

• Scratches on the cornea.
• Thinning of the cornea.
• Ulcers on the cornea.
• Ongoing inflammation of the cornea.
• The growth of blood vessels in the cornea, which typically doesn't have blood vessels.

Generally, entropion isn't preventable.

You may be able to prevent the type of entropion caused by a bacterial infection called trachoma. If your eyes become red and irritated after you visit an area where trachoma infection is common, seek evaluation and treatment right away. These areas include many countries in Africa, the Middle East and Asia.

Entropion can usually be diagnosed with a routine eye exam, including an exam of the tissues surrounding the affected eye. Also, you'll be asked about any history of eye injury, eyelid surgery or other medical conditions.

Your healthcare professional will likely:

• Examine the eyelid with a magnifying device.
• Pull on your eyelid to see how well it returns to its at-rest state.
• Ask you to open and close your eyes while watching you.
• Use a bright light and microscope to see the condition of the cornea.

Surgery is usually needed to treat entropion. But certain treatments may be used for short-term relief before surgery is done. These treatments also may be used for people who cannot undergo surgery.

Short-term treatments

There are several treatment options that can provide short-term relief.

• A soft contact lens can serve as a barrier to protect the cornea from irritation or damage.
• Skin tape can be applied to the eyelid to keep it from turning in.
• Eye ointments or artificial tears, available with or without a prescription, can give you short-term relief from symptoms.
• OnabotulinumtoxinA (Botox) injected into an eyelid can weaken muscles and allow the eyelid to turn outward. The effect may last several months.
• Stitches may be used to hold the eyelid outward. This treatment can last for several months.

Treating underlying conditions

If an underlying condition, such as an infection or inflammatory disease, is causing entropion, your healthcare professional will likely prescribe medicines to treat the condition.

Surgery

The type of surgery you have depends on the condition of the tissue surrounding your eyelid and the cause of your entropion.

In general, the surgeon removes tissue and muscle and uses sutures to pull the eyelid outward. If there is scar tissue on the lining of the eyelid, your surgeon may remove the scar tissue. If needed, a tissue graft from the roof of the mouth or nasal cavity may be used to repair the lining of the eyelid.

Before surgery, you'll receive a medicine to numb your eyelid and the area around it. You also may take a medicine to help you relax.

After surgery you may be asked to:

• Wear an eye patch for 24 hours.
• Use an antibiotic and steroid ointment on your eye.
• Use cold compresses to lessen bruising and swelling.
• Limit your activities for the first week.
• Avoid rubbing your eyes.
• Avoid wearing contact lenses for two weeks.

If you have signs and symptoms of entropion, you'll likely start by seeing your primary healthcare professional. You may be referred to a doctor who specializes in treating eye conditions, called an ophthalmologist.

Here's some information to help you get ready for your appointment.

What you can do

Before your appointment take these steps:

• List symptoms you've been having, including those that may not be related to your eyes or eyelids.
• Find a photo of yourself before the appearance of your eyelid changed, and bring this to your appointment.
• List all medicines, vitamins and supplements you take, as well as the doses and the reason for taking each one.
• List key personal and medical information, including other conditions, recent life changes and stressors.
• List questions to ask your healthcare professional.

Take a family member or friend along, if possible, to help you remember the information you're given.

Questions you might ask your healthcare professional include:

• What's the most likely cause of my condition?
• Is there a risk to my vision?
• What treatments do you recommend?
• What are the risks of surgery?
• I have other health conditions. How can I best manage them together?
• Do you have any brochures or other printed material that I can take with me? What websites do you recommend?

What to expect from your doctor

Your healthcare professional is likely to ask you a number of questions, such as:

• When did your symptoms begin?
• Have your symptoms been constant, or do they come and go?
• Have you had any earlier surgery or procedures on your eye or eyelid?
• Have you had any other eye problems, such as an eye infection or an injury?
• Are you using any eyedrops?