What is ‘Entropion’?
Entropion refers to a condition in which the margin of the upper or lower eyelid turns in on itself towards the surface of the eye. Mild entropion may cause occasional irritation, whilst severe entropion may be sight-threatening.
What are the causes of entropion?
In common with ectropion, the most common cause of lower eyelid entropion is age-related instability of the eyelid structures. Laxity of the supporting tissues leads to an instability which may result in either in-turning (entropion) or out-turning (ectropion) of the eyelid. Other less common causes of lower eyelid entropion include previous injury, and inflammations of the inner aspects of the eyelids (e.g. cicatricial pemphigoid, see below).
The most frequent cause of upper eyelid entropion, on the other hand, are not age-related changes, but disorders causing shrinkage of the back surface of the eyelid, these including eye infections such as trachoma, a rare inflammatory disease called cicatricial pemphigoid, and other causes of ocular surface inflammation. Further causes include previous trauma or surgery, and bulkiness of the tissues in the upper lid which tends to lead to a drooping of the eyelashes towards the eyeball.
What are the symptoms of entropion?
An entropic eyelid irritates the eyeball, and can lead to a cycle of ocular irritation, eyelid squeezing, and further entropion. Thus, symptoms of upper lid entropion include ocular irritation, watering, redness, and sore eyes.
Can entropion pose a risk to the eye and vision?
Untreated upper lid entropion carries a significant risk of injury to the cornea, which is the front ‘window’ of the eye. Complications of upper lid entropion include the following:
- Corneal abrasions (causing ocular irritation, watering and redness)
- Corneal ulcers (leading to more significant symptoms, which can include blurred vision, increased pain, sensitivity to light, and severe watering)
What is the treatment for entropion?
What can I do to relieve the symptoms of entropion, and protect the eye in the meantime?
What precautions are required after surgery?
After surgery, your eye will be padded overnight to reduce swelling and bruising. Once the pad is removed, it is important not to rub or touch the eyelid, but to instil antibiotic drops as instructed, typically 4 times each day with ointment at night for two weeks. Swimming should be avoided for 2 – 3 weeks after surgery, but it is safe to fly, if needed, within a few days.
A follow-up appointment is made within 10 – 14 days to monitor healing of the eyelid(s), and to check the vision and front surface of the eye. Although the stitches are absorbable, these are usually removed to reduce local irritation.
What are the complications of entropion surgery?
- Scarring: Incisions are ‘hidden’ in the upper lid skin crease or the rhytids (‘laughter lines’) at the outer corner of the eye, and tend not to be noticeable
- Recurrence of the entropion
- Irritation from the sutures, or from preservatives in the antibiotic drops
- Risk to the eyesight itself – A miniscule small risk to sight exists where any bulkiness within the lower eyelid requires removal.