17880 Entropion

Overview

Entropion is a condition where the eyelid (usually the lower one) folds inward, causing the eyelashes and the skin of the eyelid to rub against the eyeball. This can irritate the eye, making it red, watery, and uncomfortable. It can also make the eye feel scratchy, as if something is in it.

Entropion is quite common, especially in adults over 60. It is less common in children and younger adults, except when it follows scarring or trauma to the eye area.

Entropion most often affects older adults because the muscles and tissues around the eye weaken with age. It can also affect babies (congenital entropion) and people who have had eyelid surgery, burns, or infections like trachoma.

Symptoms

Common symptoms

• The eye feels red and irritated
• Watery eyes (excess tearing)
• A feeling like something is stuck in the eye (foreign body sensation)
• Soreness or discomfort in the eye
• Sensitivity to light
• Crusting or stickiness along the eyelid
• Blurred vision, especially if the cornea is scratched

Symptoms in children

• Excessive tearing and watery eyes
• Frequent eye rubbing
• Redness and irritation
• Sensitivity to bright light

Symptoms in older adults

• The same common symptoms, often worse in windy or dry conditions
• Eyelid turning inward may be more noticeable when blinking or squeezing the eyes
• If left untreated, the eye may become painful and vision may become hazy

Causes

Main causes

• Aging: the muscles and ligaments that hold the eyelid in place become loose, so the lower lid rolls inward.
• Scarring of the inner eyelid (for example, from an injury, surgery, or infection like trachoma) can pull the lid inward.
• Rarely, a baby is born with extra skin or muscle on the lower lid that makes it roll inward (congenital entropion).
• Spasm of the eyelid muscle (called orbicularis oculi) can also turn the lid inward, though this is less common.

Risk factors

• Being over 60 years old
• Previous surgery on the eyelid or eye area
• Injuries, burns, or infections of the eyelid
• Trachoma, which is a bacterial eye infection that can scar the inside of the eyelid
• Being born with certain structural differences of the eyelid

When to see a doctor

See a doctor urgently if:

• If you have severe eye pain or sudden vision changes, seek care immediately.
• If you have intense redness, swelling, or thick discharge from the eye, see a doctor the same day.
• If you think the cornea may be scratched or you see a cloudy area on the eye, get prompt medical help.

Book a routine appointment if:

• If your eye has been red, watery, or uncomfortable for more than a day or two, make an appointment with your general practitioner or an eye specialist.
• If you notice that your lower eyelid is turning inward, even if it is not painful, it is worth having it checked.
• If you have repeated eye irritation and have been using lubricating drops without improvement, tell your doctor.

Diagnosis

A doctor or an eye specialist (ophthalmologist) can usually diagnose entropion by looking at your eye and eyelid carefully. During the exam, they may ask you to blink or to squeeze your eyes shut to see how the eyelid moves. They will also check the eye for signs of irritation or damage.

Tests that may be done

• A slit-lamp exam: you rest your chin on a stand while the doctor uses a special microscope with a bright light to look at your eye and eyelid closely.
• A visual acuity test: reading letters on a chart to check your vision.
• Sometimes a test with a drop of dye (fluorescein) to see if the cornea is scratched or damaged.

What to expect at your appointment

No special preparation is needed for an eye exam. The tests are usually painless, though you may feel a brief sting from the numbing or dye drops. The doctor will gently look at your eye and eyelids, and you can ask questions at any time.

Treatment

Treatment for entropion depends on what is causing it and how much discomfort you have. The first step is usually to protect the eye and relieve symptoms. For many people, a small surgical procedure can reposition the eyelid and permanently fix the problem.

Self-care at home

• Use artificial tears (lubricating eye drops) during the day to keep your eye moist and comfortable.
• Use a lubricating eye ointment at night, as the eye may dry out more while you sleep.
• Keep your eyelid and the surrounding skin clean with a clean, warm cloth.
• Avoid rubbing your eyes, which can make the irritation worse.
• Wear sunglasses or protective eyewear when outdoors to reduce irritation from wind and dust.

Medical treatments

If symptoms are mild, your doctor may recommend only lubricating eye drops or ointments. These do not fix the inward turning, but they help protect the eye from further irritation. If an infection or inflammation is present, the doctor may prescribe medicines to treat that. For a lasting solution, surgery is usually offered. The type of surgery depends on the cause, but it often involves tightening the eyelid muscles or tightening the eyelid itself so it stays in the correct position. Surgery is usually done under local anesthetic (you are awake but the area is numbed) and takes less than an hour.

When is surgery considered?

Surgery is commonly recommended when entropion causes persistent symptoms, risks damage to the cornea, or if the eye has already been scratched. It is a very effective treatment and is considered safe for most people.

Living with this condition

Living with entropion means taking care of your eyes every day. Apply lubricating drops regularly, even if you do not feel discomfort. Gently clean your eyelids to prevent build-up, and use a cool, damp cloth to soothe irritation. If your doctor suggests surgery, plan for a few days of rest afterward and follow their instructions for recovery.

Lifestyle tips

• Avoid harsh wind, dust, and smoke, which can irritate the eye more.
• Use a humidifier in dry environments to keep the air moist.
• Protect your eyes with sunglasses that have a wrap-around design.
• When reading or using a computer, take breaks and blink often to keep the eye moist.

Diet and exercise

There is no special diet for entropion, but eating a balanced diet rich in vitamins and minerals supports overall eye health. After surgery, avoid heavy lifting and strenuous exercise for a week or two, as your doctor recommends. Walking and light activity are usually fine.

Mental health and emotional wellbeing

Living with sore, watery eyes can be frustrating and tiring. It may affect your sleep, concentration, and mood. It is normal to feel a bit anxious, especially if you are considering surgery. Talk to your doctor about your concerns and ask about any counseling or support that might help.

Prevention

Most cases of entropion are related to aging and cannot be prevented. However, you can help protect your eyelids by avoiding eye injuries, treating eye infections quickly, and not rubbing your eyes. If you have had surgery or scarring around the eye, regular check-ups with your eye doctor can help catch any changes early.

Vaccines

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Screening programmes

There is no routine screening for entropion, but regular eye examinations are important, especially as you get older. During these check-ups, the doctor can also look for early signs of eyelid problems.

Complications

If left untreated

• The eyelashes rubbing against the eye can scratch the clear surface (corneal abrasion).
• Repeated scratches can cause inflammation and a corneal ulcer, which is an open sore on the eye.
• Persistent damage can lead to scarring of the cornea and permanent vision loss.
• A severe corneal infection (keratitis) may develop if the surface is broken.

Long-term outlook

With proper treatment, the symptoms of entropion can be greatly reduced or cured. Surgery has a high success rate and most people are pleased with the results. Even if you have had the condition for a while, seeing a doctor and getting treatment early can save your vision. It is never too late to ask for help.

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