Makindo Medical Notes

Entropion

Entropion is a condition where the eyelid, usually the lower one, turns inward, causing the eyelashes and skin to rub against the eye surface. This can lead to irritation, discomfort, and potential damage to the cornea. Here is an overview of entropion, including its causes, symptoms, diagnosis, and treatment options. Entropion may be age-related, or due to conjunctival scarring from previous chemical injury, trauma, surgery or systemic conditions such as Stevens-Johnson syndrome. Surgery may be required to reposition the eyelid.

Causes of Entropion

• Age-related changes: Most common cause, where the muscles and tissues around the eyelid weaken with age.
• Scarring: Previous injuries, surgeries, or infections can cause scar tissue to pull the eyelid inward.
• Inflammation or infection: Chronic inflammatory conditions or infections can affect the eyelid's position.
• Congenital: Some individuals are born with entropion due to genetic factors affecting the eyelid's structure.
• Muscle spasm: Spasms of the muscles around the eyelid can cause temporary entropion.

Symptoms of Entropion

• Irritation and redness in the affected eye.
• Watery eyes (epiphora) due to irritation.
• Sensitivity to light and wind.
• Feeling of something in the eye (foreign body sensation).
• Blurred vision if the cornea is damaged.
• Crusting of the eyelid and mucus discharge.

Diagnosis of Entropion

• Clinical examination: ophthalmologist or optometrist to assess the eye
• Slit-lamp examination: Check the condition of the cornea with a slit lamp and under blue light with fluorescein:
• Medical history: Review causes such as previous surgeries, injuries, or chronic conditions.

Treatment Options for Entropion

• Urgent: A corneal ulcer requires taping back the eyelid away from the cornea, management as for a corneal foreign body and an ophthalmology follow-up. A corneal infection (corneal white opacity and ulcer) requires urgent referral to an ophthalmologist.
• Non-surgical treatments:
  • Lubricating eye drops and ointments: To protect the cornea and relieve irritation.
  • Botulinum toxin (Botox) injections: paralyses muscles causing the eyelid to turn inwards.
  • Skin tape: Using tape to pull the eyelid outward temporarily.
  • Soft contact lenses: Protect the cornea from irritation.
• Surgical treatments:
  • Everting sutures: Stitches placed to turn the eyelid outward.
  • Skin grafts or eyelid tightening: Removing or repositioning tissues to correct the eyelid position.
  • Full-thickness eyelid resection: Removing a portion of the eyelid to tighten and reposition it.
  • Quickert procedure: Specific technique involving sutures to evert the eyelid.

Complications of Untreated Entropion

• Corneal abrasions or ulcers due to constant friction.
• Chronic eye infections.
• Scarring of the cornea leading to vision impairment.
• Persistent discomfort and irritation.

Prevention and Management

• Regular eye examinations to detect early signs of entropion.
• Protecting the eyes from injury and infection.
• Managing chronic inflammatory conditions that may affect the eyelids.
• Using lubricating eye drops to reduce irritation and dryness.

Summary

Entropion is an inward turning of the eyelid that can cause significant discomfort and lead to serious eye complications if left untreated. It is essential to diagnose and treat entropion early to prevent damage to the cornea and maintain eye health. Treatment options range from non-surgical methods to various surgical procedures, depending on the severity and underlying cause. Regular eye check-ups and proper eye care can help manage and prevent entropion.