Eye diseases, what is entropion

By Cristiano Antonino On May 2, 2023

Entropion is an eye disease in which the edge of the eyelid is turned inwards and thus the eyelashes and skin rub against the surface of the eye

This causes irritation and discomfort on the part of the sufferer.

The eyelashes come into contact with the eyeball and scratch it causing, in some cases, injuries to the cornea that can turn into ulcers.

Normally, in people the upper and lower eyelids close tightly, protecting the eye from trauma and preventing evaporation of the tear film.

If the eyelid margins are introflected, the eyelashes rub against the eye, promoting the formation of ulcers and corneal scarring.

Entropion sufferers may have their eyelids turned all the time or they only manifest the disorder when they blink hard or squeeze them.

Entropion is more common in the elderly

It generally only affects the lower eyelid although it can occur on both eyelids.

Entropion is usually acquired, most often observed in old age due to the weakening of eyelid structures and their tendons with the passage of time.

More rarely, entropion can be spastic, caused by eye irritation, surgical trauma or blepharospasm.

In milder cases of entropion, it is possible to intervene using artificial tears and lubricating ointments that are able to alleviate the symptoms.

However, these are only valid solutions for very mild cases of entropion.

Surgery is usually necessary to completely correct this condition.

Thanks to the surgery, the eyelid tilt can be alleviated with a significant reduction in the associated symptoms.

If left untreated, entropion can cause corneal damage, eye infections and loss of vision.

For this reason, it is very important to diagnose it early.

Symptoms

The entropion sufferer has symptoms that result from friction of the eyelashes and outer eyelid against the surface of the eye.

This rubbing in fact leads to burning, irritation, pain, foreign body sensation and tearing, which can be extremely intense as the rubbing of the eyelashes against the cornea causes its surface to suffer.

In particular, the entropion sufferer may experience

discomfort in the eyes, as if something were inside them
redness, irritation or pain in the eyes
increased sensitivity to light and wind
excessive tearing
mucous secretions and crust formation on the eyelids

If a person experiences these symptoms, they should consult their doctor: if entropion is left untreated for too long, it can cause permanent damage to the eyes.

The most common cause of entropion is loosening of eyelid tissues

As we age, the muscles under the eyes tend to weaken and the tendons stretch, which is why it is more common among older people.

The presence of old scars can also give rise to entropion, as can previous surgery.

The presence of chemical burns, trauma or surgery can distort the normal curve of the eyelid.

Trachoma, which is an eye infection common in many developing countries i.e. Africa, Asia, Latin America, the Middle East and the Pacific Islands, can cause scarring of the inner eyelid, leading to entropion and even blindness (trachoma can scar the inner eyelids).

The sufferer may also have ocular muscle changes and blepharospasm (a contracture and swelling of the orbicularis muscle, the ring-shaped muscle that secures the eyelid closure).

Other causes of entropion are:

cases of ocular inflammation, caused by dryness or inflammation, leading to spasticity and rolling of the edge of the eyelid inwards against the cornea;
developmental complication, if present at birth (congenital) it can be caused by an extra fold of skin on the eyelid causing the eyelashes to bend.

Senile entropion, i.e. age-related entropion, is the most common form, the others occur much more sporadically.

Entropion is easily diagnosed during a visit to the ophthalmologist

The practitioner assesses the muscle tone and hyperlaxity of the eyelid tissues and, if he suspects that the condition is caused by the presence of scars or previous surgery, also checks the surrounding tissue.

If the eyelid margin is everted at the time of the examination, the patient should close and open the eyes slowly, a few times, until the eyelid margin turns inwards.

Through a slit-lamp test, the eyelashes in contact with the conjunctiva or cornea are seen.

The fascia is then observed, which is intended to give the vertical tension, which has detached from the tarsus.

Another test used to assess transverse laxity of the eyelid is the pinch test: with the thumb and forefinger the eyelid is moved away from the bulb and the distance is measured.

Normally, the lower eyelid should detach from the bulb by no more than 4-5 mm; furthermore, on releasing the grip, the eyelid should immediately come back into contact with the bulb.

Treatments

If the entropion condition is temporary and not severe, the sufferer can apply patches that stretch the eyelid, returning the ciliary margin to its natural position.

The cornea, in these cases, can be protected with a contact lens, eye drops or ointments based on antibiotics and re-epithelialisers, i.e., which accelerate the healing process of small scratches.

Injections of botulinum toxin A using a very fine needle into and around the eyelids can also be used to achieve the same result, especially if entropion is caused by muscle spasms.

This treatment weakens the spastic muscles for a few months and the response to this type of therapy is uneven and has possible side effects.

In the meantime, an eye drop or ointment containing antibiotics, re-epithelialisers or lubricants is often prescribed to keep the eyes moist, relieve symptoms and protect the cornea.

It is very important to safeguard the health of the cornea: the blinking caused by this condition involves the continuous passage of lashes over the cornea, which causes wounds on the surface of the eye that must be treated promptly before they become ulcers.

The state of the cornea therefore influences the choice and timing of treatment, but in the case of damage involving it, tarsotomy surgery by an ophthalmologist should be performed as soon as possible.

The operation involves removing the excess skin of the outer eyelids or tendons and the muscles are shortened with one or two stitches.

Usually local anaesthetics are applied to the muscles around the eye and only sometimes is surgery performed under general anaesthesia.

The prognosis is excellent if surgery is performed before the cornea is damaged.

In the course of time, however, it is possible to repeat the surgery to further correct the laxity of the eyelid.

After the operation, the patient must dress the eyelid with antibiotic ointment and then undergo removal of skin stitches after 7-10 days.

The incisions are not visible, as they are made in the skin folds around the eyes, and the eyelid regains its correct position.

Complications

If the patient does not resort to appropriate treatment, chronic irritation can cause pain, eye infection and scarring.

With the passage of time, the rubbing of the eyelashes on the eyeball can lead from simple initial discomfort to serious damage to the cornea: abrasions, ulcers, infections up to, in the most severe cases, actual perforations with loss of the anatomical integrity of the eye.

Corneal irritation and injury are the most serious complications of entropion because they can lead to permanent loss of vision.

In cases of extreme dryness of the eye or chronic irritation, corneal lesions can develop into ulcerations.

A corneal ulcer can become infected and cause severe vision loss if not treated in time.

The main risk is recurrence after surgery if this is limited to suturing the capsular lid band to the tarsus.

In addition, the surgery could lead to complications such as infection or scarring of the eyelid, although these are very rare occurrences.

Prevention

In general, entropion is not preventable, except in the form of trachoma: it is important to have adequate sanitary facilities and to do everything not to come into contact with insect vectors or infected disease carriers.

Pending surgery, however, measures to prevent damage to the cornea are advisable.

Suitable remedies include mechanical unrolling of the eyelid using a paper plaster, the use of a thick artificial lubricant, and the use of gels or ointments that diminish the extent of damage caused by rubbing and reduce symptoms.

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