What is Entropion?

Entropion is an inturning of the eyelid margin. When the eyelid turns inward, the eyelashes and skin rub against the eye creating a red, irritated eye sensitive to light and wind. If untreated, corneal infection and scarring may result. It may be unilateral or bilateral. Acquired entropion is classified as spastic (due to eye irritation), involutional (due to aging changes), or cicatricial (due to scarring). Lower eyelid entropion (usually involutional) is much more common than upper eyelid entropion (usually cicatricial).

Acquired Entropion

Involutional entropion is the commonest form of entropion and is generally seen in patients after the 5th decade of life. It is caused by progressive weakness of the supportive structures in the lower eyelid. The tarsal plate (tarsus)is the firm part of the eyelid that gives the eyelid its normal shape. The tarsus is supported by tendons medially and laterally and by a specialized structure (the lower eyelid retractors) from below. With age, these structures develop laxity and stretch resulting in an unstable tarsal plate. As the orbicularis muscle covering the eyelid contracts during eyelid closure, the eyelid margin is rolled in toward the eye resulting in entropion.

Acute Spastic Entropion

Acute spastic entropion is an inturning of the eyelid following irritation of the eye or inflammation. It is most frequently seen following intraocular (cataract and glaucoma) surgery in a patient who has unrecognized or mild involutional (aging) eyelid changes before surgery. The eye inflammation causes sustained squeezing or squinting of the eyelids which causes the eyelid margin to roll inward.  Corneal irritation from the eyelashes rubbing against the eye may cause further irritation and inflammation worsening the problem.

Cicatricial Entropion

Cicatricial entropion results from scarring on the conjunctival side (inside) of the lower or upper eyelid. A variety of medical conditions may lead to this form of entropion. Trauma (thermal or chemical), infection, trachoma (Chlamydia), herpes, and ocular cicatricial pemphigoid (OCP) are potential causes of cicatricial entropion.

The Treatment of Entropion

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Surgery is usually necessary to treat entropion. A temporizing measure that may correct the eyelid malposition is taping the eyelid to evert the lid margin. Surgical tape or the sticky part of a Band-Aid, placed from the lower eyelid to the cheek area, will evert the lid and relieve corneal irritation from the eyelashes. In spastic entropion, taping the eyelid may be all that is needed. Once the inflammatory cause of the entropion is relieved, the eyelid position may be normal. A variety of surgical techniques are utilized to treat entropion. In adults, these surgeries are done under local anesthesia as an outpatient. Dissolvable sutures are preferred and the eyelid typically heals over several weeks to months.

Female, 74 years old

Entropion, right lower eyelid

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