Entropion

Published by Bupa's Health Information Team, September 2010.

This factsheet is for people who have entropion, or who would like information about it.

Entropion is when the edge of the eyelid and eyelashes turn inwards and rub against the surface of the eyeball. This causes the eye to become red and inflamed.

About entropion

Entropion is a condition that affects your eyelids, usually the lower ones. The edge of your eyelid and eyelashes turn inwards and rub against the surface of your eye. The areas of your eye most affected are your cornea, the clear dome at the front of your eye, and your conjunctiva, the transparent layer that covers the white of your eye and lines your eyelids.

        
                                                            Entropion

Entropion can occur in one or both of your eyes. It can affect any age group but it's more common in older adults.

Symptoms of entropion

When you look in the mirror, you may be able to see that the edge of your eyelid and eyelashes have turned inwards and are rubbing against the surface of your eyeball.

Common symptoms of entropion include:

• watering eyes
• irritated, red eyes
• feeling like there is a bit of dirt or grit in your eye
• blurred vision

Complications of entropion

The main complications of entropion are related to your eyelashes and eyelid rubbing on your eyeball. Complications usually affect either your cornea or your conjunctiva. Some of the main complications are listed below.

• Corneal ulceration. This is an ulcer or sore on your cornea. Your eye may be red and painful, you may find bright lights uncomfortable and you may have blurred vision. A corneal ulcer can be very serious and can cause loss of sight by scarring the surface of your eye, so it's important to see your GP immediately if you have these symptoms.
• Conjunctivitis. Entropion can cause your conjunctiva to become red, swollen and inflamed, which may lead to an infection.
• Keratitis. This is when your cornea becomes inflamed. Constant rubbing of your eyelashes and the edge of your eyelid on your cornea can cause it to become irritated and sore. This can eventually lead to scarring, which could affect your vision.

Causes of entropion

There are a number of possible causes of entropion. Some of the main ones are listed below.

• Ageing. This is the most common cause of entropion. As you get older, the skin and muscles around your eyes become more relaxed and this can cause your eyelid to turn inwards.
• Damage or injury. Burns, surgery to your face or infection can all cause entropion. They can lead to scarring to the inside of your eyelid, which can cause it to turn inwards.
• Muscle spasms around your eye. These can develop when your eye becomes irritated (for example, because of an infection or after surgery).
• Congenital conditions. Entropion can be something that you're born with, though this is rare.

Diagnosis of entropion

Your GP will ask about your symptoms and examine your eyes. He or she may also ask you about your medical history.

Once you have been diagnosed with entropion, your GP will probably refer you to an ophthalmologist, a doctor who specialises in eye health including eye surgery. He or she may do some simple tests. These may include a snap back test, which involves gently pulling your eyelid away from the surface of your eye, then letting go to see where the eyelid settles. He or she may also ask you to lie down, close your eyes tightly and then open them again. If you have entropion your eyelid will turn inwards.

Treatment of entropion

Surgery is the most effective way to treat entropion. However, to ease your symptoms, your doctor may tape your eyelid down, prescribe eye ointment or give you a botulinum toxin A injection.

Self-help

Using surgical or waterproof tape can be an effective way to pull the edge of your lower eyelid and eyelashes away from the surface of your eye, which will ease your symptoms. Your doctor will show you how to apply the tape and you will need to change it regularly.

Attach one end of the tape to your eyelid, just underneath your eyelashes. Attach the other end of the tape to your cheek. The tension should pull your eyelid outwards and back into its usual position. If you use too much tension on the tape your eyelid will be pulled too far which can cause your eye to water. Open and close your eyes a few times to make sure the tape is secure.

When the tension eases and your eyelid starts to turn inwards again, change the tape. You can do this as often as you need to.

Medicines

Your doctor may advise you to use artificial tears or medicines to keep your eyes moist and ease your symptoms. You can buy these from your pharmacist. Always read the patient information leaflet that comes with your medicine and if you have any questions, ask your pharmacist for advice.

If your entropion is caused by muscle spasms, your doctor may suggest an injection of Botulinum A toxin. This paralyses the muscles that are in spasm.

Surgery

Sometimes a few stitches (sutures) are used to pull your eyelid into the correct position. This may be done as a temporary measure before you have surgery to repair the entropion. This procedure is usually carried out under local anaesthesia.

You will probably need surgery to permanently fix your entropion. The aim of surgery is to tighten your eyelid and its attachments, in order to return it to its normal position. This procedure is usually carried out under local anaesthesia in the hospital outpatient department. The anaesthetic completely blocks feeling from the eye area and you will stay awake during the procedure.

After your operation, you may need to wear an eye patch overnight. You may be given an antibiotic ointment to use for about a week.

For answers to frequently asked questions on this topic, see Common questions.

For sources and links to further information, see Resources.