Entropion

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 corneal damage. 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-weakening of eyelid retractors and supporting tissues.
• Scarring 🩹: Prior injuries, surgeries, chemical burns, trachoma, or cicatrizing conjunctivitis pull the lid inward.
• Inflammation or infection 🦠: Chronic blepharitis or conjunctival inflammation can alter lid position.
• Congenital 👶: Present from birth due to anatomical variation of the eyelid.
• Muscle spasm 💢: Orbicularis oculi spasm can cause transient entropion (spastic entropion).

Symptoms of Entropion 📋

• Irritation, gritty sensation, and redness 👀.
• Watery eyes (epiphora) 💧 due to reflex tearing.
• Photophobia and wind sensitivity 🌬️.
• Foreign body sensation 🪶 from lashes rubbing the cornea.
• Blurred vision if the cornea is abraded or ulcerated 🌫️.
• Crusting of the eyelid and mucous discharge 🧼.

Diagnosis of Entropion 🧪

• Clinical examination 🧑‍⚕️: Eversion tests, lid distraction, snap-back test, assessment of horizontal laxity and retractor function.
• Slit-lamp examination 🔬: Inspect cornea for punctate erosions/abrasions; fluorescein staining under blue light.
• Medical history 📚: Prior surgery, trauma, chemical injury, chronic blepharitis, cicatrizing conditions (e.g., SJS, OCP).

Treatment Options for Entropion 🛠️

• Urgent ⏱️: A corneal ulcer or infectious keratitis (white corneal opacity/ulcer) requires immediate eyelid taping to protect the cornea, intensive antimicrobial therapy as per corneal ulcer protocols, and urgent ophthalmology review.
• Non-surgical treatments 🧴:
  • Lubricating drops/ointments 💧: Protect cornea and reduce friction.
  • Botulinum toxin (Botox) 💉: Temporarily weakens orbicularis to evert the lid (helpful in spastic/early involutional cases).
  • Skin tape 🩹: Temporary outward traction of the lower lid.
  • Bandage soft contact lens 👁️‍🗨️: Shields cornea from lash trauma.
• Surgical treatments 🏥:
  • Everting (Quickert) sutures 🧵: Short procedure that rotates the lid margin outward.
  • Lower lid retractor reinsertion/tightening 🔧: Addresses disinsertion/attenuation of retractors.
  • Lateral tarsal strip (LTS) 📐: Corrects horizontal laxity; often combined with retractor repair.
  • Full-thickness wedge resection ✂️: Shortens the lid in severe laxity.
  • Skin grafts or mucous membrane grafts 🧫: For cicatricial entropion to lengthen the posterior lamella.

Complications of Untreated Entropion ⚠️

• Recurrent corneal abrasions and epithelial defects 🩸.
• Microbial keratitis and corneal ulceration 🦠.
• Corneal scarring and neovascularization → permanent visual impairment 👓.
• Chronic pain, photophobia, and reduced quality of life 😣.

Prevention and Ongoing Management 🛡️

• Regular eye examinations for older adults or patients with cicatrizing disease 📆.
• Eye protection and prompt care after chemical/thermal injuries 🧯.
• Control of chronic blepharitis/meibomian gland dysfunction (lid hygiene, warm compresses) 🧼🔥.
• Use lubricants to minimize corneal microtrauma while awaiting definitive surgery 💧.

Summary ✅

Entropion is an inward turning of the eyelid that causes lash–cornea contact, leading to irritation and potential sight-threatening complications. Early recognition, ocular surface protection, and timely surgical correction prevent corneal damage and restore comfort and vision. 👁️✨