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Entropion

Published by Bupa's health information team, August 2008.

This factsheet is for people who have entropion, or who would like information about it.

Entropion is when the edge of your eyelid and eyelashes turn inwards and rub against the surface of your eyeball. It can affect either eyelid, but most often affects the lower lid, and can occur in one or both of your eyes. It usually affects older people and is rare before the age of 40.

• About entropion
• Symptoms of entropion
• Complications of entropion
• Causes of entropion
• Diagnosis of entropion
• Treatment for entropion
• Further information
• Questions and answers
• Related topics
• Sources

About entropion

Entropion is a condition that affects your eyelid. The edge of your eyelid and eyelashes turn inwards and rub against the surface of your eye, specifically your cornea (the clear dome at the front of your eye) and your conjunctiva (the transparent layer that covers the white of your eye and lines your eyelids). This can cause your eye to become sore and inflamed.

There are four different types of entropion, all with different causes.

• Congenital entropion
• Spastic entropion
• Involutional entropion
• Cicatricial entropion

Symptoms of entropion

When you look in the mirror, you may be able to see for yourself that the edge of your eyelid and eyelashes have turned inwards and are rubbing against the surface of your eyeball.

Common symptoms of ectropion include:

• watering eyes
• irritated, red eyes
• feeling like there is a bit of dirt or grit in your eye
• pus or discharge

Complications of entropion

Conjunctivitis

This is an inflammation of your conjunctiva, the transparent layer that covers the white of your eye and lines your eyelids. Entropion can cause your conjunctiva to become red and inflamed, which may result in an infection.

Keratitis

This is when your cornea becomes inflamed. Constant rubbing of your eyelashes and eyelid margin on your cornea can cause it to become irritated and sore. This can eventually lead to scarring, which could result in a loss of vision.

Corneal ulceration

Corneal ulceration is when ulcers (sores) develop on your cornea, usually as a result of keratitis. It's a serious condition that can cause loss of sight. It's important to seek treatment from your GP immediately if you develop a red eye, a painful eye or it feels like something is in your eye.

Causes of entropion

The causes of entropion vary depending on what type you have.

Congenital entropion

This is a rare condition that you are born with. It happens when parts of the eyelid do not develop properly causing it to point into your cornea. This causes the edge of your eyelid and eyelashes to rub against the surface of your eye.

Spastic entropion

Spastic entropion is caused by an uncontrollable contraction of the muscle around your eyelid. This can be due to irritation of your eye and is common after eye surgery, especially if your eyelid was already turning in slightly before you had your operation. Blepharospasm, a condition that causes the uncontrollable tight closure of your eyes in the absence of any cause, can also cause spastic entropion.

Involutional entropion

Also known as senile entropion, this mainly seen in older people and usually only affects the lower eyelid. As you get older, changes to the tendons and muscles around your eyes can cause your eyelid to start turning inwards. It doesn't usually affect your upper lid because the tissue that supports your eyelids (tarsal plate) is wider and generally more stable than in the lower lid.

Cicatricial entropion

Cicatricial entropion can affect the lower or the upper eyelid, and is a result of scarring on your eyelid or conjunctiva. This may be caused by health conditions such as:

• shingles - a painful blistering rash on the body similar to chickenpox
• blepharitis - a chronic condition that causes the edge of your eyelid to become red and inflamed
• dry eye syndrome - when you don't produce enough tears, causing your eyes to become red and inflamed
• trachoma - an eye disease caused by a bacterial infection
• Stevens-Johnson syndrome - a serious skin condition that affects the entire body
• cicatricial pemphigoid - an autoimmune disease that causes blisters in the mouth and eyes

It can also be due to damage to your eye caused by surgery, burns or an accident.

Diagnosis of entropion

Your GP or optometrist (a health professional who examines eyes, tests sight and dispenses glasses and contact lenses) can diagnose your entropion. He or she will ask about your symptoms and examine you, and may ask you about your medical history.

He or she may perform some simple tests including:

• the snapback test, this involves gently pulling your eyelid away from the surface of your eye, then letting go so it can fall back into its usual position - it shows up weaknesses in the skin and muscles around the eye, and doesn't usually cause any pain or discomfort
• you may be asked to close your eyes very tightly then open them again - this allows your GP or optometrist to see how your eyelid is turning inwards

Once you have been diagnosed you will most likely be referred to an ophthalmologist, a specialist who identifies and treats eye conditions (including surgical treatments).

Treatment for entropion

Surgery is the most effective way to treat entropion. However, to give you immediate relief or if it's thought your symptoms will go away by themselves, your doctor may tape your eyelid down, prescribe eye ointment or give you a botulinum toxin A injection.

Self-help

Using surgical or waterproof tape can be an effective way to pull the edge of your lid and eyelashes away from the surface of your eye, relieving symptoms.

Place one end of the tape just below your eyelid in the middle. Pull down gently so that the eyelid is no longer rubbing on the surface and is in a normal position. Then attach the other end of the tape to your cheek. You should open and close your eyes a few times to make sure the tape is secure.

Your doctor will show you how to apply the tape initially. However, it does need to be changed regularly to be effective, so you will need to know how to do it yourself.

Medicines

Your doctor may advise you to use artificial tears to keep your eyes lubricated and provide relief. These can be bought from your pharmacist as eye drops such as Celluvisc or Geltears. Initially you should apply them hourly throughout the day, and then as you feel you need them.

Occasionally, your doctor may prescribe an antibiotic ointment, such as chloramphenicol (Chloromycetin). This is usually done to treat conditions associated with entropion, such as a corneal infection, rather than the entropion itself.

Botulinum A toxin injections

Botulinum A toxin injections can be used to paralyse the muscles causing your eyelid to turn inwards. The injection is given directly into your eyelid.

Surgery

Sometimes a few stitches (sutures) are used to pull your eyelid into the correct position as a temporary measure. This is done by passing stitches from the inside of your eyelid to a high point on the skin outside. This procedure is usually carried out under local anaesthetic. The anaesthetic completely blocks feeling from the eye area and you will stay awake during the procedure.

To permanently fix your entropion, surgery will be needed. The aim of surgery is usually to tighten the lid and its attachments to return it to its normal position. You will usually have this done as an outpatient under local anaesthetic.

After surgery, you may need to wear an eye patch overnight and will be given antibiotic drops or ointment (eg Chloromycetin) to be used for one to three weeks. Some bruising and swelling is to be expected following surgery, but this usually goes away within a couple of weeks. Once your eyelid has healed, your eye should feel more comfortable and you will no longer be at risk of developing problems with your eyesight associated with your lid being out of position.

Further information

• British Oculoplastic Surgery Society
  www.bopss.org

Related topics

• Conjunctivitis
• Local anaesthesia and sedation
• Shingles

Sources

• Korin L. Entropion and its management. Optometry Today 2006; 26 January:35-36.
• Simon C, Everitt H, Kendrick T. Oxford Handbook of General Practice. 2nd ed. Oxford: Oxford University Press, 2007
• Boboridid K, Bunce C. Interventions for involutional lower lid entropion (Review). Cochrane Database of Systematic Reviews, 2001(1)
• Entropion. GP Notebook. www.gpnotebook.co.uk, accessed 3 June 2008
• Entropion. eMedicine. www.emedicine.com, accessed 3 June 2008
• Khaw PT, Elkington AR. ABC of Eyes. London: BMJ Publishing Group, 2002

This information was published by Bupa's health information team and is based on reputable sources of medical evidence. It has been peer reviewed by Bupa doctors. The content is intended for general information only and does not replace the need for personal advice from a qualified health professional.

Publication date: August 2008.