Scleral Lenses for Entropion: Managing Inward-Turning Eyelids
Understanding Entropion and How It Affects Your Eyes
Entropion occurs when the edge of your eyelid, usually the lower lid, rolls inward toward your eye. This abnormal position forces your eyelashes and skin to rub directly against the surface of your eyeball. The condition can affect a small section of your lid or the entire length of it.
Most people notice discomfort right away, but some cases develop gradually over weeks or months. Your eyelid margin should normally rest gently against your eye without folding inward. It is also important to know that your lashes can rub your cornea even without full entropion, a condition called trichiasis or distichiasis, which may require different or additional treatment.
The constant rubbing from entropion triggers several uncomfortable symptoms that interfere with daily life. Your eyes may water excessively as your body tries to wash away the irritation. You might also feel a gritty or sandy sensation, as if something is stuck under your eyelid.
- Persistent tearing or watery discharge
- Redness and visible blood vessels on the white of your eye
- Sensitivity to light and wind
- A feeling that something is poking or scratching your eye
- Mucus buildup, especially in the morning
Your cornea is the clear front surface of your eye that focuses light and protects the inner structures. When eyelashes constantly scrape across it, they create tiny scratches called corneal abrasions. Over time, repeated rubbing can lead to scarring that blurs your vision permanently.
Left untreated, chronic irritation may also cause infections or ulcers on your cornea. We often recommend scleral lenses as an urgent protective measure while planning longer-term solutions.
Entropion becomes more common as we age because the muscles and tendons that hold your eyelid in position weaken over time. This age-related form is called involutional entropion. People over 60 face the highest risk, especially if they have a history of eye inflammation or injuries. Cicatricial entropion develops when scarring from infections, inflammation, or injuries pulls the lid inward. Spastic entropion can occur after eye irritation or surgery, and congenital entropion is present from birth.
Previous eye surgeries, chronic infections, and certain skin conditions can also change the structure of your eyelid. We evaluate every patient individually to understand the underlying cause, because the type of entropion often guides which treatments will work best.
Some symptoms indicate that your cornea is already suffering significant damage and needs urgent care. If you notice any of the warning signs below, you should seek same-day urgent eye evaluation. If our office is closed or your symptoms are severe, go to an emergency department or urgent eye care facility immediately. These signs may point to a corneal ulcer or infection that can progress quickly and threaten your vision.
- Rapid decrease in vision clarity
- Intense pain that does not improve with lubricating drops
- Discharge that is thick, yellow, or green
- A visible cloudy or white spot on your cornea
- Worsening sensitivity to light or inability to tolerate light
- Inability to keep your eye open or sudden intolerance of your contact lens
- Rapidly increasing redness or swelling of your eyelids
- New halos around lights or sudden blurring while wearing your lenses
- Severe eye pain accompanied by headache or nausea
How Scleral Lenses Protect Your Eyes from Entropion
Scleral lenses are much larger than standard soft or rigid contact lenses. They vault over your entire cornea and rest on the sclera, which is the white part of your eye. This design keeps the lens clear of your cornea when properly fit, creating a fluid-filled space underneath.
Because they are designed to vault above your cornea rather than rest on it, scleral lenses can provide a protective cushion even when your eyelashes continue to turn inward. The dome shape physically blocks lashes from reaching the delicate surface of your eye. Proper fitting and ongoing monitoring are essential to maintain adequate vault and avoid corneal contact.
When you wear a scleral lens, your inward-turning eyelashes contact the smooth outer surface of the lens instead of your cornea. This barrier often stops the scratching and rubbing that causes pain and damage. The liquid reservoir beneath the lens also bathes your cornea in preservative-free saline, which can help soothe irritation.
- Lashes typically slide over the rigid lens material
- The fluid layer helps hydrate your cornea
- Many patients experience significant relief during lens wear
- Comfort and protection depend on proper fit and regular follow-up
In some cases, the fluid reservoir may support healing of existing corneal abrasions, but using scleral lenses for active epithelial defects or as a bandage lens requires close supervision by our eye doctor. Any therapeutic use must also account for infection risk and the need for frequent monitoring.
We may recommend scleral lenses if your entropion is causing ongoing corneal damage but you cannot have immediate surgery. They work well for patients who need time to prepare for a surgical procedure or who have medical conditions that delay other treatments. Scleral lenses also help when temporary measures like tape or ointment do not provide enough relief.
Some patients with mild or intermittent entropion use scleral lenses long term if they prefer to avoid surgery. We discuss your goals and health status to decide if this approach fits your needs.
Scleral lenses are not ideal for everyone with entropion. If your eyelid turns inward so severely that inserting or removing a lens becomes difficult or unsafe, we will explore other options first. Patients with active eye infections must clear the infection before wearing any contact lens.
Very young children or individuals who cannot handle lens care independently may benefit more from surgical correction. Additional cautions include reduced corneal sensation, low corneal endothelial cell counts, significant ocular surface inflammation or blepharitis that may need treatment first, glaucoma or ocular hypertension requiring intraocular pressure monitoring, and immunosuppression that increases infection risk. We always weigh the risks and benefits for your specific situation.
The Evaluation and Fitting Process
Your first visit includes a thorough assessment of your eyelid position, corneal health, and tear film quality. We examine how much your lid turns inward and whether your lashes are actively touching your eye. Our eye doctor also checks for signs of infection, scarring, or other complications. We assess the conjunctiva for scarring or inflammation that might indicate cicatricial entropion or underlying inflammatory disease, and we evaluate for blepharitis or ocular surface conditions that may need treatment to improve lens tolerance.
- Detailed inspection of your eyelid anatomy and movement
- Evaluation of corneal abrasions using special dyes and lights
- Measurement of your tear production and quality
- Discussion of your symptoms and daily challenges
Modern scleral lens fitting relies on precise imaging technology to map the unique shape of your eye. We use instruments that capture thousands of data points across your cornea and sclera. These measurements guide the design of a lens that vaults properly over your cornea without pressing on it.
The imaging process is quick and painless. You simply look into a device while it scans the front surface of your eye. We then send these measurements to a specialized lab that fabricates your custom lenses.
Before ordering your final lenses, we usually have you try diagnostic lenses from our fitting set. These trial lenses let us see how the lens vaults over your cornea, how it moves with each blink, and whether it provides adequate protection from your inward-turning lashes. We check the fit using a special microscope and may adjust the lens parameters based on what we observe.
You will wear the diagnostic lens for a short period so we can evaluate comfort and vision. We may try several different sizes or curves to find the best match for your eye.
Once we finalize your lens design, the lab typically takes one to three weeks to manufacture your custom scleral lenses. Some complex orders may take longer if we request special features or materials. We will let you know the expected timeline and provide temporary protection if your cornea needs immediate shielding.
When your lenses arrive, we schedule a dispense visit to teach you insertion, removal, and care techniques. You will practice under our guidance until you feel confident.
Daily Use and Maintenance of Your Scleral Lenses
Inserting a scleral lens is different from applying a standard contact lens because you fill it with preservative-free saline first. We recommend sitting at a clean table with a mirror and holding the lens on the tips of two or three fingers. Fill the bowl of the lens to the brim with saline, then lean forward and place the lens directly onto your eye in one smooth motion.
- Wash and dry your hands thoroughly
- Inspect the lens for cracks, chips, or debris
- Fill the lens completely with sterile preservative-free saline
- Look straight ahead or slightly down and gently place the lens on your eye
- Check immediately for air bubbles under the lens by looking in different directions
- If you see bubbles, remove the lens, refill it, and reinsert
- Once you confirm no bubbles and comfort is acceptable, blink normally
Removing a scleral lens requires a small suction tool called a plunger. You moisten the plunger with saline, lean over a towel or mirror, and gently press it against the lower edge of the lens. A slight tug should break the seal and allow the lens to come off. Never try to pinch or slide the lens off like a soft contact, as this can damage your eye or the lens.
If the plunger does not release the lens immediately, add a drop of saline to your eye and try again. Use gentle technique and avoid excessive force. Plunger placement and approach can vary by individual anatomy, so follow the specific training we provide. Stop and contact our office if removal causes sharp pain, if your eye becomes very red, or if the lens feels stuck repeatedly.
Every time you remove your lenses, clean them by rubbing both sides with an approved cleaner designed for rigid gas permeable lenses. Rinse the lenses according to the instructions for your prescribed lens care system. If you use sterile preservative-free saline for rinsing, make sure it is single-use only and remember that saline does not disinfect your lenses. Place them in a clean case filled with fresh disinfecting solution as directed by our eye doctor.
If you use a hydrogen peroxide disinfection system, it is critical that the peroxide neutralizes completely before the lenses touch your eye. Never rinse your lenses with unneutralized hydrogen peroxide, never fill the lens bowl with peroxide, and never put peroxide directly in your eye. This can cause severe pain and injury. Always follow the full neutralization cycle specified by the product instructions.
- Rub each lens for at least 20 seconds per side
- Rinse away all traces of cleaner before storing
- Replace your lens case every one to three months
- Let lenses soak for the full disinfection time listed on your solution
To protect your lenses and your eyes from dangerous contamination, avoid the following practices:
- Never use tap water or any non-sterile water on your lenses, case, or plungers
- Do not swim, shower, or use hot tubs while wearing your lenses
- Do not top off old solution with new solution
- Do not reuse or refill single-use saline vials
- Never share lenses or lens care supplies with others
We usually suggest wearing your scleral lenses during waking hours and removing them before sleep to give your eyes a chance to breathe. Most patients start with six to eight hours per day and gradually increase wearing time as comfort allows. Your cornea needs oxygen, so overnight wear is typically not recommended unless we specifically advise it for your situation. Do not sleep or nap in your lenses unless our eye doctor has given you explicit instructions to do so.
If you experience redness or discomfort, remove the lenses and give your eyes a rest. You can resume wearing them once your symptoms resolve, but contact our office if problems persist. Remove your lens immediately and seek guidance if you develop pain, increased light sensitivity, discharge, or reduced vision.
Your eyes can change shape over time, especially if your entropion worsens or if you undergo eyelid surgery. You may notice that lenses that once felt comfortable now cause redness, fogging, or reduced wearing time. Excessive bubbles under the lens or a lens that moves too much can also signal a poor fit.
Schedule a follow-up visit if you see any of these changes. We will reassess the fit and modify or replace your lenses as needed to maintain optimal protection and comfort.
While scleral lenses can provide significant benefits for entropion, they do carry risks that require your attention and cooperation. Understanding these potential complications helps you recognize warning signs early and maintain safe lens wear.
- Microbial keratitis or eye infection, especially if hygiene or water-avoidance rules are not followed
- Corneal swelling or hypoxia if the lens fit is too tight or wear time is excessive
- Midday fogging or vision fluctuation related to debris or lens coating
- Redness or discomfort from suction, poor fit, or excessive wearing time
- Allergic or toxic reactions to contact lens solutions
- Handling-related corneal abrasions during insertion or removal
You can reduce these risks by following strict hand hygiene, avoiding all water exposure while wearing or handling lenses, adhering to the recommended wearing schedule, attending all follow-up appointments, and removing your lenses immediately if you experience pain, redness, discharge, light sensitivity, or vision changes. Prompt reporting of any symptoms allows us to address problems before they become serious.
Other Treatments Your Eye Doctor May Recommend
Eyelid tape can hold your lid in a normal outward position temporarily, especially at night. We may show you how to apply small strips of hypoallergenic tape to gently pull your lid away from your eye. Lubricating ointments provide another layer of protection by coating your cornea and reducing friction from rubbing lashes.
- Tape works best for mild or intermittent entropion
- Ointments keep your eye moist and comfortable overnight
- Both options are inexpensive and easy to use at home
- Neither tape nor ointment fixes the underlying eyelid problem
For patients whose symptoms are mainly from misdirected lashes, we may perform epilation in the office. This involves removing individual lashes that rub the cornea using fine forceps. Relief is temporary because lashes grow back, but it can help while you prepare for more definitive treatment. In select cases, we may also consider temporary everting sutures placed in the office to rotate the eyelid margin outward and provide short-term relief.
In select cases, we may consider botulinum toxin injections to temporarily weaken the muscle that is pulling your eyelid inward. This treatment can provide relief for a few months while you plan a more permanent solution. The injections are quick and cause minimal discomfort, but results fade over time and repeat treatments are necessary.
This approach may be considered for patients who cannot tolerate surgery right away or who have spasms that worsen their entropion. We will discuss whether this option aligns with current best practices for your condition.
Surgery is the only way to permanently fix most cases of entropion. Our eye doctor may refer you to an oculoplastic surgeon who will tighten or reposition the muscles and tendons that hold your eyelid in place. The specific procedure depends on the cause of your entropion. Involutional entropion typically requires retractor muscle reinsertion and horizontal lid tightening, while cicatricial entropion may need grafting or scar release to address conjunctival scarring. The procedure usually takes less than an hour, and most patients recover within a few weeks.
Success rates are high, and many people no longer need protective lenses after healing. We can continue to provide scleral lenses for corneal protection until you are ready for surgery or if you choose not to pursue it.
You can often combine scleral lenses with other treatments for better overall results. For example, you might wear the lenses during the day and use eyelid tape at night, or continue lens wear while waiting for a scheduled surgery date. Some patients use lenses after surgery if residual irritation or dryness persists.
We coordinate your care to ensure that all therapies work together safely. Always tell us about any drops, ointments, or other treatments you are using so we can adjust your lens care routine if needed.
Frequently Asked Questions
Scleral lenses manage symptoms by protecting your cornea from damage, but they do not correct the underlying eyelid position. You will still have entropion while wearing the lenses. Surgery or other interventions are necessary if you want to fix the turned-in eyelid permanently.
Some medical insurance plans cover scleral lenses when they are deemed medically necessary to protect your cornea. We provide documentation and diagnostic codes to support your claim, but coverage varies widely by plan. Check with your insurance company to understand your benefits and any out-of-pocket costs you may face.
We can fit scleral lenses for both eyes at the same appointment, or we may start with the more severely affected eye first. Bilateral entropion is common, and wearing lenses in both eyes follows the same care routine as wearing a single lens. You will simply need two sets of supplies and a bit more time for daily insertion and removal.
Scleral lenses can be safe and effective for protecting your eye when your eyelid remains in an abnormal position, provided the lenses are properly fit and you follow all care and hygiene instructions. The rigid lens surface is designed to prevent your lashes from touching your cornea. However, you must stop wearing the lenses and seek care immediately if you develop pain, increased light sensitivity, discharge, or vision changes, as these may indicate infection or other complications. Severe entropion or significant mucus and inflammation may reduce lens tolerance and require alternate management strategies.
Using scleral lenses when you have an active corneal abrasion or ulcer requires direct guidance and close supervision from our eye doctor. In some cases, scleral lenses can serve as a therapeutic bandage to promote healing, but this must be managed carefully to avoid infection and ensure proper monitoring. Do not attempt to self-treat corneal injuries with contact lenses. Always contact our office for an evaluation and individualized care plan.
We typically schedule a follow-up within one week of dispensing your lenses to check the fit and address any questions. After that, you will return every three to six months for routine evaluations, or sooner if you notice discomfort or changes in vision. Regular visits help us catch fit issues early and keep your eyes healthy.
Next Steps for Entropion and Scleral Lens Care
If you are experiencing symptoms of entropion or your eye doctor has recommended scleral lenses, our team is here to guide you through every step of the process. We will evaluate your eyelid position, design lenses that protect your cornea, and work with you to plan the best long-term treatment. Reach out to our office to schedule a comprehensive eye examination and discuss whether scleral lenses are the right choice for your situation.