Understanding Entropion

Entropion is a condition where the eyelid turns inward. This can happen slowly and the inward rolling of the lid often causes the eyelashes and skin to rub against the surface of the eye.

If this rubbing happens over an extended period of time, it can result in eye discomfort or pain, or a sticky eye. This may also lead to a corneal ulcer, which can cause scarring, and result in a loss of vision.

The eyelid may be turned in all the time, or just when you blink hard or squeeze your eyes shut tight. The condition is often more common in older adults. 

Signs and symptoms

The signs and symptoms can include:

• Irritation or pain at the front of the eye
• Eye redness
• Eye discomfort or feeling there is something in your eye
• Watery or teary eyes
• Light sensitivity
• Eyelid crusting (sometimes)
• Corneal infection or ulcer
• Loss of vision

What causes Entropion?

While lower lid entropion is more common, it can occur in the upper lid too. Lower lid entropion tends to happen as a result of aging changes that make the lid become lax from weakening muscles and loose skin, causing it to flip inwards.

This tends to be intermittent to start with but often results in constant entropion that needs to be corrected to avoid infection, ulcer, or scarring. Upper lid entropion can be a result of scarring from infection, disease, or injury. 

Entropion can also be caused by trachoma, a common eye disease caused by bacteria found in tropical countries. The eye disease affects the front of the eye with repeated infections causing scarring on the inside of the lid, disrupting the function of the eyelid, eventually causing it to turn inwards. This results in rubbing of the cornea from the eyelashes, damaging/scarring the surface, and leading to severe vision loss or blindness.

In very rare cases, the defect is present at birth.

How your eye works: The basics

There are four main components that help the eye function: 

• The Cornea and Lens are found at the front of the eye. They focus light coming into the eye, which allows you to form an image on the retina. 
• The Retina is at the back of the eye. It is a layer of tissue that senses light and colour, converting them into electrical signals.
• The Optic Nerve transmits electrical signals from the retina to the brain for interpretation. This lets us understand the information sent through from the eye.
• If the cornea is damaged, this can result in vision loss problems, it is therefore important to ensure entropion is treated before it damages the cornea, either by causing a corneal ulcer or scarring. 

How is Entropion diagnosed?

Entropion can quite easily be diagnosed from sight, but your doctor will most likely ask about the possible causes, such as previous eye diseases, injuries, or even chemical exposure. 

Eye test

Your doctor may perform a snap test to try and confirm the diagnosis. The snap test gently pinches the eyelid, lifting it up to see how fast it will snap back into place. If there is a loss of collagen and muscle tone around the eye, this test can help confirm the visual diagnosis. 

How do you treat Entropion? 

In most cases, surgery is needed to correct the problem. However, there are a few treatments that help provide short-term relief, and lubricating eye ointment may be prescribed to help protect the cornea while you are waiting for treatment.

A short-term treatment often recommended by doctors is to gently pull and tape the eyelid to the outside of the eye. By doing this, you should create enough tension to flip the eyelid away from the surface of the eye.

Sometimes botulinum toxin injections (Botox) can be used to weaken the muscles pushing the lid inwards.

Surgery

Often a minor operation is required to treat the problem. This is usually done under a local anaesthetic, and as an outpatient procedure. Eye drops or an antibiotic ointment may be prescribed for recovery, as well as an eye patch to protect the eye overnight.

There are a few different procedures that can be done for the lower lid and one for the upper, all of which use absorbable stitches - they dissolve (and fall out) in the weeks following surgery. 

Everting sutures

This is a quick surgery that involves placing stitches inside the lid and stiffening it, which stops it from turning in. You can have both lids treated by the operation. The procedure is as follows:

• Numbing drops are placed on your eyes
• Your lids are cleaned with iodine antiseptic solution
• A local anaesthetic is injected (stings for a bit)
• Stitches are placed (only takes a few minutes)
• Antiseptic is washed away
• Ointment is applied
• Eye pad may be put on

Quickert’s procedure

If the entropion returns after having the operation of the everting suture, Quickert’s procedure might be recommended. It is a slightly bigger procedure that takes around 45 minutes - it is able to tighten the lid, helping turn it outwards, back into the normal position. The procedure is as follows:

• Your face is cleaned with antiseptic, and sterile drapes are placed around your face.
• The lid is tightened by removing a small section, and then the ends are stitched together.
• Everting sutures are also placed inside the lid.
• An ointment is applied in the lid, and an eye pad is put on.

Jones procedure

This operation is very similar to Quickert’s procedure, however, the skin of the lid is cut and deep stitches are used to tighten the muscle, opening the lid.

Anterior Lamellar reposition

The upper lid is operated on to help reposition the lid outwards away from the eye. This is done by a small cut being made and stitches put in, similar to the lower lid procedures. It takes around 45 minutes.

After surgery care

The eye pad is often left for at least two hours to help reduce the bruising, and the eyelids can then be cleaned carefully using cotton wool or tissues with cooled, boiled water.

You can use the prescribed ointment on the eyes and stitches, and paracetamol or Ibuprofen can help any soreness after the anaesthetic wears off. The discomfort should ease within a day or two, and eyelids may appear swollen or bruised for the first week or so.

As with all surgeries, there can be complications, such as infection or eyelid scarring. These are not common but you should be aware of the risks of surgery, and discuss them with your doctor.