Entropion is a common eyelid condition that can significantly impact your eye health. If you find yourself experiencing discomfort or irritation due to an inward-turning eyelid, don't hesitate to reach out to the experienced professionals listed with Specialty Vision. Find a top eye doctor near you today!
Entropion is an eyelid condition in which the eyelid, most commonly the lower lid, turns inward, causing the eyelashes and skin to rub against the eye's surface. This constant friction can be very uncomfortable and, if left untreated, can lead to serious complications like corneal ulcers, scarring, and even permanent vision loss. According to the American Academy of Ophthalmology, 2.1% of Americans over 60 have this condition .
Entropion, a condition where the eyelid turns inward, can be caused by a wide range of factors. The most common cause is the natural aging process, but it can also stem from genetic conditions, previous injuries or surgeries, infections, and inflammation. Understanding the specific cause is key to determining the most effective treatment.
The most frequent cause of entropion is involutional, meaning it is related to aging. As we age, the tissues supporting our eyelids begin to lose strength and elasticity. Specifically, the canthal tendons that anchor the eyelid relax, the eyelid retractor muscles weaken or detach, and the orbicularis oculi muscle (the muscle that closes the eyelid) can override the lower border of the eyelid, pushing it inward. This is the most prevalent form of entropion, affecting 2.1% of individuals over 60. The likelihood increases dramatically with age, with a prevalence of 0.9% for those 60-69 years old, 2.1% for those 70-79, and 7.6% for people over 80.
The general weakening of eyelid tissues with age results from several specific anatomical changes. These factors can occur alone or in combination to cause the eyelid to lose its stability and turn inward.
In some cases, entropion is present from birth or caused by an inherited genetic condition. These structural issues can lead to an inward-turning eyelid from a young age. Some conditions include:
Cicatricial entropion is caused by scarring (tarsoconjunctival contracture) of the inner surface of the eyelid. This scarring can pull the eyelid margin inward. Any trauma, procedure, or condition that results in scar tissue formation can put an individual at risk. Common causes include:
This type of entropion is caused by spasms of the orbicularis oculi muscle surrounding the eye. These spasms can cause the eyelid to turn inward forcefully. Spastic entropion is often triggered by irritation, infection, or inflammation of the eye. It frequently occurs after intraocular surgery, especially in patients who already have some degree of age-related eyelid weakness that may have gone unrecognized before the procedure. The condition creates a problematic cycle: the muscle spasm turns the eyelid in, the lashes then rub against and irritate the cornea, and this irritation perpetuates the muscle spasm.
Understanding the signs of entropion can help you seek timely professional advice. The symptoms primarily result from abnormal contact between the eyelid, lashes, and the eye’s surface, and may appear intermittently or persistently depending on the severity and type of entropion. If symptoms worsen, it’s important to consider the possibility of corneal damage, which can manifest as increased pain, visible changes in the cornea, or blurred vision. If you experience these symptoms, consult with an oculoplastic surgeon promptly.
The most common and persistent symptom of entropion is a feeling of constant irritation. The rubbing of the eyelashes against the cornea can feel like there is always something in your eye, such as a grain of sand. This sensation does not go away with blinking and can significantly impact your daily comfort and quality of life.
The continuous friction from an inward-turning eyelid leads to irritation and inflammation of the conjunctiva (the clear membrane covering the white of the eye), and potentially the cornea itself.
The continuous friction can cause a dull, aching pain or sharp, stabbing pains, particularly when blinking or in bright light.
Irritation is a powerful trigger for your eye's tearing reflex. As your eyelashes and skin rub against the cornea, your eye tries to protect itself by producing an excessive amount of tears. This leads to watery eyes, a condition known as epiphora, where tears may spill over onto your cheeks.
An eye that is constantly irritated by entropion becomes very sensitive. Exposure to bright light (photophobia) or wind can be intensely uncomfortable or even painful. You may find yourself squinting frequently or needing to wear sunglasses indoors to cope with normal lighting conditions.
The ongoing inflammation and irritation can cause your eye to produce a stringy, mucous-like discharge. This discharge can dry on the eyelids and lashes, especially overnight, leading to significant crusting upon waking. This can make your eyelids feel sticky and difficult to open in the morning.
While entropion may seem like a minor issue, ignoring it can lead to significant consequences.
You should contact our office or seek emergency care immediately if you have been diagnosed with entropion and you notice a rapid increase in eye redness, severe eye pain, a sudden and significant increase in light sensitivity, or any noticeable decrease or blurriness in your vision. These are all signs of a potential corneal abrasion, ulcer, or infection that must be treated urgently.
Persistent friction from entropion can lead to corneal abrasions or even corneal ulcers, which, if left untreated, can cause scarring and permanent vision impairment. Contact lens wearers, those with autoimmune conditions, a history of eye trauma, burns, dry eye, or frequent infections, and the use of steroid eye drops can increase the risk of developing corneal ulcers. A corneal ulcer is a serious, sight threatening condition that requires immediate treatment.
The damage to the cornea from constant irritation creates an ideal environment for bacteria and other pathogens to invade. Scratches on the cornea compromise its protective barrier, heightening the risk of infections such as keratitis. These infections can lead to further complications, including tissue death, which can result in severe and irreversible damage to the eye if not promptly addressed.
Over time, the ongoing irritation and scarring caused by entropion can distort the cornea's shape, leading to blurred vision. Chronic damage to the corneal surface, if left untreated, can progress to significant vision loss, and in extreme cases, blindness. The risk of vision impairment increases the longer the condition goes untreated, making early intervention crucial for preserving eye health.
In most cases, diagnosing entropion is straightforward and can be done during a comprehensive eye examination. Our doctor will talk with you about your symptoms and then perform a few simple, painless tests to observe how your eyelid functions and check the health of your eye.
The first step is a careful visual examination. Our eye doctor will look closely at your eyelids and lashes while your eye is open and as you blink naturally. We will check for the tell-tale signs of entropion, such as an inward-turning eyelid margin, redness, or other signs of irritation caused by your lashes rubbing against the eye's surface.
To understand the cause of the entropion, we perform simple in-office tests. Our doctor may ask you to blink forcefully or squeeze your eyes shut, which can help reveal an entropion that isn't always present. We may also perform a "snap-back test," where we gently pull your lower eyelid down to see how quickly it returns to its normal position. This helps us assess the eyelid's laxity and muscle tone.
To see if your eyelashes have caused any scratches on your eye's surface, we may use a special vegetable-based dye called fluorescein. A small, safe amount of this yellow dye is applied to your eye, which allows us to use a blue light to clearly see any areas of irritation or abrasion on your cornea. This helps us understand the severity of the condition and guide your treatment.
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Smet, M., & Van den Broeck, T. (2014). Eyelid abnormalities: Diagnosis and management. Ophthalmic Clinics, 32(1), 85-90.
Bell, A., & McNeely, S. (2017). Fluorescein staining in the diagnosis of ocular surface disease. Journal of Corneal and Ocular Surface Disease, 6(3), 231-239.
These treatments can provide relief from the symptoms of entropion, such as irritation and discomfort, but they do not address the underlying cause of the condition. While they can help manage the condition temporarily, they do not offer a permanent solution.
Medical tape can be carefully applied to pull the eyelid outward, stopping it from rubbing against the eye. This method provides temporary relief from irritation caused by the eyelid turning inward.
A special medical glue can be used to gently turn the eyelid outward, offering short-term relief from discomfort. This helps to prevent the eyelid from irritating the eye.
Botox is injected into the muscles around the eyelid to temporarily relax them, which helps keep the eyelid in a more normal position. This can help prevent the eyelid from turning inward and causing irritation.
Laser skin resurfacing is not a standard treatment for entropion and, by tightening the anterior lamella, can occasionally worsen an inward-turning lid. It is mainly used for cosmetic resurfacing or to address mild lower-lid laxity; definitive correction of entropion usually requires procedures that reposition the lid retractors or tighten the canthal tendons.
Don't let entropion affect your comfort and vision. Our experienced doctors are here to provide the care you need. Contact us today to schedule a consultation and ensure your eyes are healthy and comfortable.
Surgical treatments are often necessary for more durable, long-term results, as they address the primary underlying issues causing entropion, rather than just alleviating symptoms. These procedures are designed to correct the structural abnormalities of the eyelid that lead to the condition, ensuring a more permanent resolution.
This procedure involves using sutures to attach the eyelid in such a way that it is turned outward, providing immediate relief from the irritation caused by the eyelid rubbing against the eye. While it is effective in the short term, the effects may not be permanent, and the procedure may need to be repeated as it may not work indefinitely for all patients.
This surgery is often recommended for cases where entropion is caused by weakened or loose eyelid muscles, especially in the lower eyelid. The procedure works by tightening the outer part of the eyelid, which not only helps to correct the position of the eyelid but also ensures that it remains stable and functional for a longer period.
In cases where the muscles responsible for pulling the eyelid down are weak, damaged, or detached, this surgical technique can help by reattaching those muscles to restore the natural function of the eyelid. By fixing the position of the eyelid, this surgery reduces the risk of further irritation or damage to the eye caused by improper eyelid alignment.
When entropion is caused by multiple factors, a combination of surgical techniques may be recommended to achieve better and longer-lasting results. Typically, this involves both the lateral tarsal strip and lower lid retractor reattachment procedures, which together address multiple underlying issues to offer a more comprehensive and lasting solution.
In cases where scarring has led to entropion, a more advanced surgical approach may be necessary. This type of surgery often involves using tissue from inside the mouth to replace damaged tissue around the eyelid, correcting the alignment and function of the eyelid and providing a permanent solution for patients suffering from scarring-related entropion.
Entropion can recur after treatment, though the likelihood depends on various factors, including the type of treatment used, the underlying cause of the condition, and the patient's individual healing process.
Recurrence is more likely if the condition is secondary to scarring (e.g., from trauma, surgery, or inflammatory conditions like blepharitis). While scar tissue can contribute to the recurrence of entropion, it does not always lead to it. The extent of scarring and the surgical technique used are key factors in determining whether recurrence will occur. Scar tissue may cause the eyelid to turn inward again over time, but careful surgical management can mitigate this risk.
Age-related entropion involves a combination of factors such as skin laxity, muscle weakness, and tendon dysfunction. While modern techniques like eyelid tightening may reduce recurrence, there is no guarantee of a lower recurrence rate, especially in advanced cases. If the underlying muscle and tendon issues, including the lower eyelid retractors, are not adequately addressed, recurrence is still a possibility. Tailoring the surgery to the patient's specific anatomy is essential to minimize this risk.
When entropion results from nerve damage (e.g., facial palsy) or congenital abnormalities, recurrence can be more challenging to manage unless the underlying causes are appropriately addressed. Proper management of these contributing factors, whether through surgical interventions or other treatments, can help reduce the chance of recurrence. However, managing the neurological or structural issues is critical to preventing further eyelid misalignment.
Regular follow-up visits after surgery are crucial for detecting early signs of recurrence, such as irritation, redness, or discomfort. If any of these symptoms arise, it is essential to consult an ophthalmologist or eyelid specialist promptly. Early intervention, including minor adjustments or additional procedures, can help prevent further complications and protect eye health.
By adhering to pre- and post-operative care guidelines, the risks of recurrence are minimized, leading to better comfort and preservation of vision. Surgical treatment is highly effective in restoring eyelid function and preventing long-term complications. In conclusion, early diagnosis, appropriate surgical treatment, and careful management of underlying conditions are critical for the best outcomes, preserving both vision and quality of life.
Living with entropion can cause significant discomfort and interfere with daily activities. Tasks like reading or being outdoors may become difficult due to the constant irritation of the eye. While lubricating ointments and artificial tears offer temporary relief, they are only adjuncts until a more lasting treatment is available.
Daily eye care, such as using eye drops to keep the surface moist, can reduce irritation caused by eyelash friction. However, these measures do not correct the eyelid misalignment and are considered supportive rather than curative.
Entropion is when the lower eyelid turns inward, causing the eyelashes to rub against the eye, leading to irritation, discomfort, and potential corneal damage if untreated.
The main cause is aging, which weakens the muscles and tendons that hold the eyelid in place. It can also result from scarring, nerve damage, or congenital conditions.
A doctor examines the eyelids, checks for signs like irritation or inward turning, and uses tests like fluorescein staining and slit-lamp examination to assess corneal damage.
Treatment includes temporary non-surgical options like taping or Botox, and more permanent solutions like surgery (lateral tarsal strip or reattachment of lower lid retractors).
Yes, if untreated, the constant irritation can cause corneal abrasions and scarring, leading to vision loss. Early treatment is crucial to prevent long-term damage.
Don't let entropion affect your comfort and vision. Our experienced doctors are here to provide the care you need. Contact us today to schedule a consultation and ensure your eyes are healthy and comfortable.
Entropion, an inward-turning eyelid, can lead to discomfort and serious eye issues. Seek professional help for diagnosis and treatment.
