Entropion

Overview

Entropion (en-TROH-pee-on) is a condition in which your eyelid turns inward so that your eyelashes and skin rub against the eye surface. This causes irritation and discomfort.

When you have entropion, your eyelid may be turned in all the time or only when you blink hard or squeeze your eyelids shut. Entropion is more common in older adults, and it generally affects only the lower eyelid.

Artificial tears and lubricating ointments can help relieve symptoms of entropion. But usually surgery is needed to fully correct the condition. Left untreated, entropion can cause damage to the transparent covering in the front part of your eye (cornea), eye infections and vision loss.

Symptoms

The signs and symptoms of entropion result from the friction of your eyelashes and outer eyelid against the surface of your eye. You may experience:

• The feeling that something is in your eye
• Eye redness
• Eye irritation or pain
• Sensitivity to light and wind
• Watery eyes (excessive tearing)
• Mucous discharge and eyelid crusting

When to see a doctor

Seek immediate care if you have received a diagnosis of entropion and you experience:

• Rapidly increasing redness in your eyes
• Pain
• Sensitivity to light
• Decreasing vision

These are signs and symptoms of cornea injury, which can harm your vision.

Make an appointment to see your doctor 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. If you leave entropion untreated for too long, it can cause permanent damage to your eye. Start using artificial tears and eye-lubricating ointments to protect your eye before your appointment.

Causes

Entropion can be caused by:

• Muscle weakness. As you age, the muscles under your eyes tend to weaken, and the tendons stretch out. This is the most common cause of entropion.
• Scars or previous surgeries. Skin scarred by chemical burns, trauma or surgery can distort the normal curve of the eyelid.
• Eye infection. An eye infection called trachoma is common in many developing countries of Africa, Asia, Latin America, the Middle East and Pacific Islands. It can cause scarring of the inner eyelid, leading to entropion and even blindness.
• Inflammation. An irritation of the eye caused by dryness or inflammation can lead you to try to relieve the symptoms by rubbing the eyelids or squeezing them shut. This can lead to a spasm of the eyelid muscles and a rolling of the edge of the lid inward against the cornea (spastic entropion).
• Developmental complication. When entropion is present at birth (congenital), it may be caused by an extra fold of skin on the eyelid that causes turned-in eyelashes.

Risk factors

Factors that increase your risk of developing entropion include:

• Age. The older you are, the greater your chances of developing the condition.
• Previous burns or trauma. If you've had a burn or other injury on your face, the resulting scar tissue may put you at higher risk of developing entropion.
• Trachoma infection. Because trachoma can scar the inner eyelids, people who have had this infection are more likely to develop entropion.

Complications

Corneal irritation and injury are the most serious complications related to entropion because they can lead to permanent vision loss.

Prevention

Generally, entropion isn't preventable. You may be able to prevent the type caused by trachoma infection. If your eyes become red and irritated after you visit an area where trachoma infection is common, seek evaluation and treatment immediately.

Diagnosis

Entropion can usually be diagnosed with a routine eye exam and physical. Your doctor may pull on your eyelids during the exam or ask you to blink or close your eyes forcefully. This helps him or her assess your eyelid's position on the eye, its muscle tone and its tightness.

If your entropion is caused by scar tissue, previous surgery or other conditions, your doctor will examine the surrounding tissue as well.

Treatment

The treatment approach depends on what's causing your entropion. Nonsurgical treatments are available to relieve symptoms and protect your eye from damage.

When active inflammation or infection causes entropion (spastic entropion), your eyelid may return to its normal alignment as you treat the inflamed or infected eye. But if tissue scarring has occurred, entropion may persist even after the other condition has been treated.

Surgery is generally required to fully correct entropion, but short-term fixes can be useful if you can't tolerate surgery or you have to delay it.

Therapies

• Soft contact lens. Your eye doctor may suggest that you use a type of soft contact lens as a sort of corneal bandage to help ease symptoms. These are available with or without a refractive prescription.
• Botox. Small amounts of onabotulinumtoxinA (Botox) injected into the lower eyelid can turn the eyelid out. You may get a series of injections, with effects lasting up to six months.

• Stitches that turn the eyelid outward. This procedure can be done in your doctor's office with local anesthesia. After numbing the eyelid, your doctor places several stitches in specific locations along the affected eyelid.

  The stitches turn the eyelid outward, and resulting scar tissue keeps it in position even after the stitches are removed. After several months, your eyelid may turn itself back inward. So this technique isn't a long-term solution.

• Skin tape. Special transparent skin tape can be applied to your eyelid to keep it from turning in.

Surgery

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

If your entropion is age related, your surgeon will likely remove a small part of your lower eyelid. This helps tighten the affected tendons and muscles. You'll have a few stitches on the outside corner of your eye or just below your lower eyelid.

If you have scar tissue on the inside of your lid or have had trauma or previous surgeries, your surgeon may perform a mucous membrane graft using tissue from the roof of your mouth or nasal passages.

Before surgery you'll receive a local anesthetic to numb your eyelid and the area around it. You may be lightly sedated to make you more comfortable, depending on the type of procedure you're having and whether it's done in an outpatient surgical clinic.

After surgery you might need to:

• Use an antibiotic ointment on your eye for one week
• Use cold compresses periodically to decrease bruising and swelling

After surgery you will likely experience:

• Temporary swelling
• Bruising on and around your eye

Your eyelid might feel tight after surgery. But as you heal, it will become more comfortable. Stitches are usually removed about a week after surgery. You can expect the swelling and bruising to fade in about two weeks.

Lifestyle and home remedies

To relieve the symptoms of entropion until you have surgery, you can try:

• Eye lubricants. Artificial tears and eye ointments help protect your cornea and keep it lubricated.
• 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.

Preparing for an appointment

If you have signs and symptoms of entropion, you're likely to start by seeing your primary care doctor. He or she may refer you to a doctor who specializes in treating eye disorders (ophthalmologist).

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

What you can do

Before your appointment, make a list of:

• All medications, vitamins and supplements you take, including the doses
• Symptoms you've been having and for how long
• Other eye conditions, injuries or surgeries you've had
• Questions to ask your doctor

For entropion, some basic questions to ask your doctor include:

• What's the most likely cause of my symptoms?
• What kinds of tests do I need? Do they require any special preparation?
• Is this condition temporary or long lasting?
• Can entropion damage my vision?
• What treatments are available, and which do you recommend?
• What are the risks of surgery?
• What are the alternatives to 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 doctor is likely to ask you a number of questions, such as:

• When did you first begin experiencing symptoms?
• Have your symptoms been continuous or occasional?
• Have you had any previous eye 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 taking any blood thinners?
• Are you taking aspirin?
• Are you using any eyedrops?