Patients often go to see their doctor when they notice that eyelashes and skin are rubbing against the cornea of the eye, causing a watery eye, inflammation, discomfort, irritation, and sometimes pain.
For some people, the eyelid turns in permanently, while for others, this only happens when they shut their eyelids tightly or blink hard.
Entropion is normally due to a genetic issue. In some rare cases, the lower eyelid may have an extra fold of skin. Bilateral entropion is when both eyes are affected.
Entropion is very rare in children and young adults. It normally occurs in patients over the age of 60 years.
Symptoms of entropion
Signs and symptoms of entropion may include:
- Irritation and a feeling that something is stuck in the eye
- Excessive watering of the eyes onto the face, known as epiphora
- Eyelid crusting, or mucous discharge
- Pain in the eye
- Sensitivity to light, or photophobia
- Sensitivity of the eye to wind
- Sagging skin around the eye
- Redness in the whites of the eyes.
Vision problems may occur, especially if there is damage to the cornea.
Causes of entropion
As the skin and muscles become looser around the eye, the eyelid may start to turn inwards, causing irritation.
Aging is one reason. As people get older, there is more loose skin around the eyelids, the muscles under the eyes weaken, and the tendons and ligaments relax more.
Scarring of the skin can contribute. Scarring can occur as a result of trauma, surgery, radiation to the face, or chemical burns. It can alter the normal curvature of the eyelid.
Bacterial infection, such as trachoma, can cause the inner surface of the eyelids to become rough and scarred. The infection is uncommon in developed nations, but it affects tens of millions of people globally.
Spasms in the eyelid can occur as a result of eye surgery. This can cause the eyelid to fold inwards.
Congenital causes can, in some rare cases, mean that entropion is present from birth.
How is entropion diagnosed?
A routine physical examination of the eye is normally sufficient to diagnose entropion. The physician may pull on the eyelids and ask the patient to close their eyes tightly or blink hard. Special diagnostic tests are not usually necessary.
If the condition may have been caused by scar tissue or a previous surgical intervention, the doctor will also check the surrounding tissue and inside the eye lids.
Knowing why the entropion occurs will help to find the most effective treatment.
Treatment for entropion
In mild cases, eye drops may be enough to soothe some of the symptoms.
Severe cases can cause pain and loss of vision. Severe irritation can cause a corneal ulcer to develop, which can then become infected.
If there is a risk to the health of the eye, the doctor may recommend surgery.
After treatment for an infection or active inflammation, the eyelid will normally stop folding inwards, and it will return to its normal position.
If this does not happen, and the eyelid still causes problems, surgery may be needed.
If surgery is not possible at that moment, or if the patient does not want to undergo surgery, there are some temporary treatments that can help.
Transparent skin tape
Transparent skin tape is stuck to the eyelid to stop it from folding inwards. One end is placed near the lower eyelashes while the other is stuck to the upper cheek. The patient needs to learn how to do this.
Up to three stitches are placed along the eyelid, and they force it to turn outward.
After the stitches are removed, the eyelid will normally stay in position for several months.
Stitches can be done at a doctor's office, with local anesthesia, but they are a temporary solution.
The doctor may inject botox into the lower eyelid, and this usually relaxes the lid muscles and prevents them from contracting inward. This works especially in the case of spasms.
A series of injections are required.
The positive effects are temporary, and they will not last more than 6 months. Patients with temporary entropion may prefer this procedure, because by the time the effects of botox have gone, so has the temporary entropion.
Several types of surgery are effective for treating entropion. Factors influencing the choice will include the underlying cause, the state of the surrounding tissue, and the patient's age and overall health.
Surgery can help to prevent damage to the eyes.
If the condition is due to aging and the relaxation of muscles, ligaments, and tendons, the surgeon will take out a small part of the lower eyelid, as this will tighten the tendons and muscles. After the procedure, the patient will have some stitches on the outside corner of the eye, or just under the lower eyelid.
If the condition is caused by scar tissue or a previous surgical procedure, the surgeon may take some skin from behind the ear or from the upper eyelid, and graft it onto the lower eyelid.
After surgery, the patient will have to wear an eyepatch for approximately 24 hours.
The physician will prescribe antibiotics to protect against post-surgical infections, and steroids to prevent inflammation. Acetaminophen products such as Tylenol or paracetamol may help alleviate discomfort and swelling. Applying a cold compress gently to the area may help.
Within around 7 days, the stitches are removed. The operation takes about 45 minutes.
Complications of entropion
The cornea can become irritated and damaged. A corneal ulcer may develop, which can become infected and lead to severe loss of vision if it is not treated promptly.
Corneal abrasions may occur, and a loss of the surface of the epithelial layer of the cornea.
Lubricating ointments and eyedrops can help to reduce the irritation and damage while the patient is awaiting surgery.