Entropion (Turning in of the lower eyelid)

What is Entropion?

Entropion is a condition where the lower eyelid turns inwards towards the eyeball. It is often intermittent at first but can become permanent. Because the eyelashes are also turned in, the eye can be scratched by the eyelashes.

What causes entropion?

The commonest reasons for an entropion developing are:

  • Increasing age. The eyelid loses its elasticity and tone and a very tiny muscle in the lower eyelid (the lower eyelid retractor) becomes loose, making the eyelid unstable. The lid may turn inwards (entropion) or outwards (ectropion) when this happens.
  • Scarring inside the eyelid. Occasionally, scarring conditions of the lining of the eyelid (the conjunctiva) may lead to entropion.

What symptoms can occur with entropion?

The commonest symptoms from entropion of the lower eyelid are:

  • Watering of the eye. The eyelashes irritate the surface of the eye and cause watering.
  • Soreness of the eye. The eyelashes scratch the surface of the eye.
  • Redness of the eye due to irritation.
  • Discharge from the eye. The eye will often produce more tears and mucous when there is entropion present.
  • Rarely, the front surface of the eye (the cornea) can develop an ulcer which can be very serious for the health of the eye. Corneal ulcers are commoner when entropion is present.

How is entropion treated?

Entropion is usually treated by surgery. It is not major surgery. Sometimes other forms of treatment may be used to temporarily correct the entropion. This can include:

  • Tape on the eyelid. Tape can be very carefully placed to stop the eyelid turning in, but this needs to be done very carefully after being shown how to do this by your doctor to avoid the tape itself scratching your eye
  • Injections of Botox. This can be helpful for some weeks whilst an operation is organized
  • Temporary stitches in the eyelid. Occasionally stitches can be put in to the eyelid as an office procedure. This may be effective for some months.

What sort of anaesthetic will be used?

Nearly all entropion operations are performed with a local anaesthetic.  Before any local anaesthetic is injected into the skin of the eyelid, your anaesthetist will give you some medicine in the form of a sedative and pain killer so that the eyelid injection will not be painful and is often not even noticed or remembered. During the operation, you will however be aware that the eyelid is being operated on but it will not be painful. It is important for you to say if there is any pain during the operation.

What is done during an entropion operation?

What is done during an entropion operation will depend on the causes of the entropion. In most cases the eyelid will be “tightened”, usually by making a very small incision at the outer corner of the eye and pulling the eyelid across to reattach it just inside the rim of the bony eye socket at the outer corner (this is sometimes called a “tarsal strip” operation). In combination with this, there may be other procedures performed. These can include the following:

  • Repairing the lower eyelid retractors. This is usually done through  an incision just under the eyelashes which heals very well and does not leave a noticeable scar
  • Special sutures through the eyelid to help turn it outwards.

How long will I stay in hospital?

Most patients having entropion surgery can go home on the day of surgery, but a few are kept in overnight after the operation. You will be told at the time the surgery is booked how long you will stay in hospital.

What problems can occur with entropion surgery?

Nearly all entropion operations are successful, but occasionally problems may occur. These include the following:

  • Failure to correct the entropion. This is rare, and another operation may be needed.
  • Scarring. There is always a small scar at the outer corner of the eye where the eyelid is tightened, but this fades over 2 – 3 months and is very rarely noticeable after that time. The scar under the eyelashes fades very quickly
  • Recurrence of the entropion. This rarely occurs many years later as the tissues continue to gradually lose their elasticity with time.
  • Infection. This is very rare with eyelid surgery and can be treated with antibiotics.
  • Bleeding. A little bleeding in the first 24 hours is common. Occasionally, there may be more significant bleeding  5 – 10 days after surgery, usually from the outer corner of the eye. If this happens, clean the eye, fold several tissues up, close the eye and hold the tissues firmly over the area that is bleeding (or the whole eye if you are not sure) for 10 minutes. Repeat a second time if this does not help.