Entropion is a condition where an eyelid, most often the lower one, turns inward. This inversion causes the eyelashes and surrounding skin to rub against the eye’s surface. The constant friction leads to discomfort and irritation. Though it can affect either eyelid or both eyes, it is most commonly observed in the lower eyelid. This inward turning can occur continuously or only when the eye is squeezed shut or during forceful blinking.
Types of Entropion and Their Causes
Entropion can arise from several distinct causes, leading to different classifications of the condition. Involutional entropion, the most common type, frequently develops as a natural part of aging. As individuals age, the muscles and tendons beneath the eyes can weaken, and the connective tissues supporting the eyelid may stretch, leading to eyelid laxity and instability. This relaxation allows the eyelid margin to roll inward.
Congenital entropion is a less common form present at birth. It can result from developmental complications, such as an extra fold of skin on the eyelid that directs the eyelashes inward, or from abnormal eyelid muscle development. While rare, genetic factors may play a role in its occurrence.
Spastic entropion occurs when irritation, infection, or inflammation of the eye triggers involuntary spasms of the eyelid muscles. These forceful contractions can cause the eyelid to turn inward. This creates a cycle where corneal irritation perpetuates the muscle spasm.
Cicatricial entropion results from scarring or fibrous tissue contraction on the inner surface of the eyelid. This scarring can be a consequence of chemical burns, trauma, previous surgeries, or chronic inflammatory conditions. Infections like trachoma can also cause significant scarring leading to this type of entropion.
Identifying the Symptoms
The inward turning of the eyelid and the constant rubbing of eyelashes against the eye surface produce a range of uncomfortable symptoms. Individuals often experience a sensation as if something is in their eye, along with eye irritation or pain. This friction can also cause eye redness and excessive tearing, as the eye attempts to flush out the irritant.
Many people with entropion also report sensitivity to light, known as photophobia, and increased sensitivity to wind. Mucous discharge and crusting of the eyelids are other common signs. If the irritation leads to corneal damage, individuals may notice blurry vision. These symptoms arise directly from the mechanical irritation and potential injury to the cornea.
Diagnosing Entropion
Diagnosing entropion involves a comprehensive eye examination performed by an eye care professional. The doctor will begin by discussing the patient’s symptoms and medical history. During the examination, the healthcare provider visually inspects the eyelid’s position and observes how it moves, sometimes asking the patient to blink or squeeze their eyes shut forcefully.
This assessment helps determine the exact position of the eyelid relative to the eye, its muscle tone, and its tightness. Special tests are not necessary for diagnosis, as the condition is evident upon visual inspection. If scarring is suspected as a cause, the doctor might also examine the conjunctival tissue.
Treatment Approaches
Treating entropion aims to alleviate discomfort, protect the eye from further damage, and restore the eyelid to its proper alignment. Temporary measures can provide relief while awaiting more definitive treatment. Lubricating eye drops and artificial tears can moisten the eye surface and reduce irritation. Soft contact lenses may also be recommended to act as a protective bandage over the cornea.
Another temporary solution involves taping the eyelid to reposition it outward, or using stitches to hold it in a more favorable position for a few months. Small injections of botulinum toxin into the eyelid muscles can temporarily relax them, helping to turn the eyelid outward for several months. These non-surgical options offer short-term symptomatic relief but do not provide a permanent correction.
Surgical correction is the definitive treatment for entropion. The specific surgical technique depends on the underlying cause and severity of the condition. For age-related entropion, a surgeon might tighten the eyelid muscles and tendons by removing a small portion of the lower eyelid.
Other procedures involve reattaching weakened eyelid retractors or modifying the orbicularis oculi muscle. Scarring from previous trauma or infections may require more complex procedures, such as grafting tissue from other areas to reconstruct the eyelid. Most entropion surgeries are outpatient procedures performed under local anesthesia, providing quick relief from symptoms.
Preventing Complications
Leaving entropion untreated can lead to serious and potentially irreversible complications that affect eye health and vision. The continuous rubbing of eyelashes and skin against the cornea can cause significant damage to its surface. This friction can result in corneal abrasions and can progress to corneal ulcers.
These injuries make the eye more vulnerable to bacterial growth and infections, as the natural protective barriers are compromised. If corneal damage is severe or repeated, it can lead to scarring on the cornea. Corneal scarring can permanently impair vision and result in vision loss. Therefore, prompt medical attention for entropion helps prevent these long-term consequences and preserve vision.