ENTROPION

Introduction 1

Entropion is an ophthalmological condition in which the eyelid margin attains an abnormal position by moving inward. Entropion causes irritation and damage to the eye surface. The inward turning lashes can rub against the cornea causing pain, blurred vision, and tearing. This condition is common in older individuals and can be treated with medical or surgical options. The lower lid is more commonly affected than the upper eyelid. 

What Are The Signs And Symptoms Of Entropion 1,2

The signs and symptoms of the entropion depend on the stage and severity of the disease. Entropion once developed may result in the following symptoms:

• Red-eye
• Feeling of foreign body inside your eye
• Pain in the eye due to friction between eyeball and eyelid
• Increased sensitivity to light and wind
• Excessive tearing from the affected eye
• Itching
• Discharge and crusting
• Visual problems in the case of chronic disease

What Are The Causes And Risk Factors Of Entropion 1,2

Entropion can result from the following:

• Previous scarring of the eyelid

• Scar tissue retracts the skin or tissue around it. Any scar over or around the eyelid may result in abnormal eyelid rotation.

• Infection of affected eyelid

• Infections such as trachoma may lead to malpositioning of the eyelid

• Inflammation of the eyelid

• Any irritation of the eye may cause the patient to rub the eye. Excessive rubbing may result in spasm and inward rolling of eyelids.

• Muscle weakness

• With increasing age, eyelid muscles become weaker and the eyelids become more lax. This can lead to inward turning of the eyelid. This is the most common cause of entropion.

• Previous surgery

• Any previous surgery around the eyelid would leave a scar that can distort the normal anatomy.

• Congenital defect

• Entropion may result from a congenital defect e.g extra fold of eyelid skin.

The following are the factors that increase the odds of developing entropion:

• Increasing age

• Trachoma

• Trachoma is the most common cause of reversible blindness. It is caused by bacteria in developing countries. Trachoma results in scarring and malposition of the eyelids.

• Burn injuries

• When the burn site heals it contracts the tissue around it, thereby potentially distorting the normal anatomy.

How Is Entropion Diagnosed?

Entropion can be diagnosed simply by the history and examination of the patient. Generally, further tests are not needed. However, it must be differentiated from other eye conditions that mimic entropion e.g epiblepharon.

Some tests may rarely be done to rule out autoimmune conditions e.g anti basement membrane antibodies.

How Is Entropion Treated? 3

Entropion can be managed medically or surgically depending on the severity of symptoms.

• Treatment of the underlying cause

• Treat any underlying infection, blepharitis etc.

• Artificial tears/Ocular lubricants

• These are used to minimize frictional damage between the eyelashes and the ocular surface

• Botulinum toxin injection

• Botox injections may be used to relax the eyelid muscles and prevent inward rotation. This procedure is typically repeated every 3 to 4 months.

• Positioning tape

• A small adhesive tape can be placed below the eyelid to position it correctly.

• Surgical procedures

• Eyelid tightening

• In this procedure lateral tarsal muscle is shortened in length to provide eyelid tightness.

• Retractor reinsertion

• The lid retractor muscles help to open and close the lids. In this procedure, this muscle is shortened.

• Mucous membrane grafts

• They may be used to replace scarred tissues.

How Is Entropion Prevented?

Increasing age is the main risk factor of entropion formation so prevention is difficult. But trachoma is one condition that can be prevented to minimize the chances of entropion.

References

1. Entropion - Symptoms and causes. (2021, January 14). Mayo Clinic. Retrieved December 8, 2021, from https://www.mayoclinic.org/diseases-conditions/entropion/symptoms-causes/syc-20351125#:%7E:text=Entropion%20is%20a%20condition%20in,rub%20against%20the%20eye%20surface.
2. Entropion: Causes, Symptoms & Treatment. (n.d.). Cleveland Clinic. Retrieved December 8, 2021, from https://my.clevelandclinic.org/health/diseases/17880-entropion
3. DeBacker, C., MD. (2021, July 19). Entropion: Background, Pathophysiology, Epidemiology. Medscape. Retrieved December 8, 2021, from https://emedicine.medscape.com/article/1212456-overview

Author

Eye Surgeons Associates Drs. Zuhair H. Peracha, Manal H. Peracha-Riyaz, Eric Zuckerman, Matthew Pieters, and Leila Siblani are dedicated to excellence in eye care and service. We utilize the latest treatment methods and procedures, including routine eye care, cataract surgery, glaucoma treatment, retinal disease management, diabetic eye treatment, and eyelid surgery.