Cicatricial entropion is an eye condition where the eyelid turns inward, causing the eyelashes to rub against the surface of the eye. This inward turning results from scarring or fibrous tissue contraction on the inner surface of the eyelid. The constant rubbing can lead to discomfort and irritation. If left unaddressed, this condition has the potential to impact vision.
Understanding Cicatricial Entropion
Cicatricial entropion is a distinct form of entropion, characterized by scarring or fibrous tissue contraction of the inner eyelid. This scarring, often affecting the tarsoconjunctiva (the inner lining and supporting plate of the eyelid), physically pulls the eyelid margin inward. The abnormal inward rotation of the eyelid margin then causes the eyelashes to rub against the cornea and conjunctiva.
This mechanism differentiates cicatricial entropion from other types, such as involutional entropion, which typically occurs due to age-related weakening of eyelid muscles and tendons. In contrast, cicatricial entropion is defined by the presence of scar tissue that shortens the posterior lamella, the inner layer of the eyelid. This shortening creates an imbalance between the anterior and posterior eyelid lamellae, leading to the characteristic inward rotation.
Causes of Scarring
The scarring that defines cicatricial entropion can arise from various underlying conditions. Chronic inflammation or infection of the eye is a common contributor.
One significant infectious cause is trachoma, a bacterial infection caused by Chlamydia trachomatis. This leads to repeated infections and scarring of the conjunctiva, which can progress, causing the upper eyelid to turn inward. Trachoma is a leading cause of preventable blindness worldwide. Chronic conjunctivitis, a persistent inflammation of the conjunctiva, can also lead to similar scarring over time.
Autoimmune conditions represent another category of causes, where the body’s immune system mistakenly attacks its own tissues, leading to inflammation and subsequent scarring. Ocular cicatricial pemphigoid (OCP) is an example, characterized by chronic inflammation that results in progressive scarring of the conjunctiva, eventually leading to eyelid retraction and inward turning. Stevens-Johnson syndrome (SJS) and its more severe form, toxic epidermal necrolysis (TEN), are acute, life-threatening mucocutaneous reactions that can cause extensive scarring of the conjunctiva and eyelids.
Trauma or injury to the eyelid can also result in the formation of scar tissue that pulls the eyelid inward. This includes chemical burns, thermal burns, or lacerations that damage the delicate eyelid structures. Furthermore, previous eyelid surgery or radiation therapy can sometimes lead to iatrogenic (medically induced) scarring that causes or exacerbates cicatricial entropion.
Recognizing the Symptoms
Individuals experiencing cicatricial entropion often report a persistent foreign body sensation, as if something is constantly in their eye. This uncomfortable feeling arises directly from the eyelashes continually rubbing against the delicate surface of the cornea and conjunctiva. The mechanical irritation caused by the misdirected lashes frequently leads to significant eye irritation, redness, and a dull to sharp pain in the affected eye.
Excessive tearing, medically known as epiphora, is another common symptom. This occurs as a reflex response to the constant irritation, where the eye produces more tears to try and wash away the perceived foreign object. Sensitivity to light, or photophobia, can also develop due to the inflammation and irritation of the ocular surface. Some individuals may also notice a mucus discharge from the affected eye, which can be a sign of ongoing irritation or secondary infection.
The continuous abrasion from the eyelashes can lead to more serious complications on the cornea. This includes corneal abrasions, which are superficial scratches on the cornea, and in more severe cases, corneal ulceration, which involves a deeper defect in the corneal tissue. These corneal injuries can cause significant pain and, if left untreated, may lead to corneal scarring, thinning, or the growth of new blood vessels onto the cornea (neovascularization), all of which can ultimately impair vision.
Diagnosis and Treatment
Diagnosing cicatricial entropion typically begins with a comprehensive physical examination of the eye and eyelid by an ophthalmologist. During this examination, the doctor will observe the position of the eyelid margin and eyelashes, noting any inward turning or signs of scarring. The ability to easily evert the eyelid, or turn it outward, can help distinguish cicatricial entropion from other types, as scarring often makes eversion difficult or impossible.
A slit-lamp examination is also performed, using a specialized microscope to get a magnified view of the eye’s anterior structures, including the cornea, conjunctiva, and eyelid margins. This allows the ophthalmologist to assess the extent of corneal damage, such as abrasions or ulcers, and to identify any scarring or changes in the conjunctival tissue. A thorough review of the patient’s medical history is also undertaken to identify potential underlying causes of the scarring, such as previous infections, autoimmune conditions, or trauma.
Treatment for cicatricial entropion often involves a combination of non-surgical and surgical approaches, with surgery typically being the definitive solution. Non-surgical options are primarily aimed at providing temporary relief from symptoms. Lubricating eye drops and ointments can help reduce friction and irritation from the eyelashes rubbing against the eye. Therapeutic soft contact lenses can also be used to create a barrier between the eyelashes and the ocular surface, protecting the cornea. In some cases, botulinum toxin injections may be used to temporarily relax muscles if there is an associated spastic component, but these non-surgical methods are generally palliative and do not correct the underlying anatomical problem.
Surgical correction is usually necessary for long-term resolution of cicatricial entropion. The primary goal of surgery is to reposition the eyelid margin outward and address the underlying scarring. The specific surgical technique chosen depends on the severity of the scarring and its underlying cause. Techniques may involve full-thickness eyelid reconstruction, where sections of the eyelid are carefully reshaped, or the use of grafts to replace scarred tissue. Skin grafts or mucosal grafts, often taken from the patient’s mouth or nasal septum, may be used to lengthen the shortened posterior lamella and restore the eyelid’s normal position. The prognosis following surgical intervention is generally excellent, leading to significant improvement in comfort and vision.