Diseases & Conditions

Entropion

Entropion is a condition in which your eyelid turns inward so that your eyelashes and skin rub against the eye surface, causing irritation and discomfort. When you have entropion, your eyelid may be turned in all the time, or it may only turn inward when you blink forcibly or squeeze your eyelids shut tightly. Entropion occurs most often in older people, and it affects women more often than men. Entropion typically affects only your lower eyelid.

Artificial tears and lubricating ointments can help relieve symptoms of entropion, but you'll likely need surgery to correct it. Left untreated, entropion can cause damage to the clear part of your eye (cornea), which can lead to vision loss.

The symptoms of entropion result from the friction of your eyelashes and outer eyelid against the surface of your eye. Signs and symptoms include:

• The feeling that there's something in your eye
• Redness of the white part of your eye
• Eye irritation or pain
• Sensitivity to light and wind
• Watery eyes (excessive tearing)
• Mucous discharge and eyelid crusting
• Decreased vision

When to seek medical advice
If you feel like you constantly have something in your eye, or you notice that some of your eyelashes seem to be turning in toward your eye, make an appointment to see your doctor for an evaluation. If you leave entropion untreated for too long, it can cause permanent damage to your eye, so be sure to use artificial tears and eye-moisturizing ointments to protect your eye in the meantime.

If you know that you have entropion, be alert for symptoms of cornea exposure or ulcers, including rapidly increasing redness, pain, light sensitivity or decreasing vision. If you experience any of these vision-threatening signs and symptoms, seek immediate care in an emergency room.

Usually, entropion can be diagnosed with a routine eye exam and physical examination. Your doctor may pull on your eyelids during the exam, or ask you to close your eyes forcefully, in order to assess your eyelid's position on the eye, as well as its muscle tone and tightness.

If your entropion is caused by scar tissue or a previous surgery, your doctor will examine the surrounding tissue as well. Understanding how other conditions cause your entropion is important in choosing the correct treatment or surgical technique.

The most serious complication associated with entropion is corneal irritation and damage. Because your eyelashes and eyelid are constantly rubbing the cornea, it is more susceptible to corneal breakdown and ulcers, which can cause permanent loss of vision. Lubricating eyedrops and ointments can help to protect your cornea and prevent damage until you have surgery to correct entropion.

Although treatments are available to relieve symptoms and protect your eye from damage, you'll likely need surgery to correct entropion. When active inflammation or infection causes the condition, your eyelid may return to its normal alignment as you treat the inflamed or infected eye. However, entropion often persists after the other condition has cleared up.

Temporary treatments
Short-term fixes can be useful if you can't tolerate surgery or you have to delay it for a while. Effective temporary treatments include:

• Skin tape. Special transparent skin tape can be applied to your eyelid to keep it from turning in. Place one end of the tape near your lower eyelashes, then pull down gently and attach the other end of the tape to your upper cheek. Ask your doctor to demonstrate proper technique and placement of the tape.
• Stitches that turn the eyelid outward. This procedure can be done in your doctor's office with local anesthesia. After numbing the eye, your doctor places two to three stitches in specific locations along your eyelid. The stitches turn the eyelid outward, and resulting scar tissue keeps it in position even after the stitches are removed. There's a high likelihood that your eyelid will turn itself back inward within several months of the stitching, however, so it isn't a long-term solution.
• Botulinum toxin (Botox). Small amounts of botulinum toxin injected in the lower eyelid can turn the eyelid out. You'll get a series of injections and the effects will last three to six months. This treatment can help if you have temporary spastic entropion immediately after another eye surgery, because the entropion will resolve itself before the effects of botulinum toxin wear off.

Surgery
Most cases of entropion require surgery. There are several different surgical techniques for entropion, depending on the cause and the condition of the surrounding tissue. Before the surgery, you'll receive a local anesthetic to numb your eye area, and you'll be lightly sedated using oral or intravenous (IV) medication to make you more comfortable.

If your entropion is caused by muscle and ligament relaxation due to aging, your surgeon will likely remove a small part of your lower eyelid, which tightens the tendons and muscles of the lid. You'll have a few stitches on the outside corner of your eye, or just below your lower eyelid.

If you have scar tissue or previous surgeries, the surgeon may need to use a skin graft, taken from your upper eyelid or behind your ear, to correct the entropion.

Following your surgery, your doctor may require you to wear an eye patch for 24 hours, and then use an antibiotic and steroid ointment on your eye several times a day for one week. You may also use cold compresses periodically to decrease bruising and swelling, as well as acetaminophen (Tylenol, others) for pain. Avoid drugs containing aspirin, because they tend to increase bleeding.

At first your eyelid might feel uncomfortable, but as you heal, the soreness and irritation will diminish. Most people say that their symptoms are relieved almost immediately after surgery. You'll get your stitches removed about a week after your surgery. For at least a month following surgery, take care not to pull on your eyelid to apply eyedrops.