Entropion: Overview and More

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Entropion is a condition in which the inward turning of the upper or lower eyelid causes the eyelashes to rub against the front of the eye (cornea). If it is not treated, entropion can cause irritation and infection.

Eye with lower lid entropion.

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Types of Entropion

Entropion can affect the upper or lower eyelids, but the lower lids are more commonly involved.

The most common type of entropion occurs in people over the age of 60.

The older a person gets, the more likely they are to develop entropion. It occurs in about 2% of people over the age of 79, and in 7.6% of people over the age of 80.

There are four types of entropion.

  • Involutional, or age-related entropion: Age-related entropion is the most common type. The connections between eyelid structures get looser as a person ages, making it more likely that the muscles of the lower lid will turn inward.
  • Spastic entropion: This type of entropion occurs when irritation, eye spasm, or surgery makes the eye forcefully close, causing the eyelashes to rub up against the cornea.
  • Cicatricial entropion; This form of the condition is typically caused by scarring on the inside of the eyelid. It's usually associated with other eye problems, such as dry eye, blepharitis, viral conjunctivitis, or previous eye surgery.
  • Congenital entropion: With this uncommon form of entropion, one or both eyelids are turned inward at birth. Surgery is often needed to prevent vision loss.

Entropion (when the eyelids turn inward) is easy to confuse with ectropion (when the eyelids turn outward).

Entropion Symptoms

At first, people with entropion might only have occasional symptoms. However, if the condition is not treated, the symptoms tend to become more consistent over time.

Possible symptoms of entropion include:

  • Blurry vision
  • Discharge
  • Pain or discomfort (feeling as if there is something in the eye)
  • Itching
  • Redness
  • Watering or tearing

Causes

The cause of entropion depends on the type. For example, age-related entropion happens as the eyelid muscles become weakened and the tendons of the eyelids get loose.

Other possible causes include:

  • Blinking forcefully
  • Eyelid spasms
  • Other eye conditions (such as dry eye or blepharitis)
  • Scarring
  • Surgery
  • Trauma to the eye

Diagnosis

Eye doctors usually diagnose entropion by looking at the eye and do not need to use any special tools. However, they might need to perform a few simple tests to rule out other eye problems that can cause similar symptoms.

Before making a diagnosis of entropion, an eye doctor will make sure that a person's symptoms are not being caused by another condition, such as:

  • Distichiasis: The growth of eyelashes from the meibomian glands, the oil glands on the eyelid edges (also called "double eyelashes")
  • Epiblepharon: A horizontal fold of skin at the eyelid margin that contributes to lashes being slightly inverted or vertical
  • Eyelid retraction: A condition that causes lashes to be hidden
  • Trichiasis: Occurs when the eyelashes do not grow in their usual direction

Treatment

If it is not treated, entropion can lead to eye infections or vision loss. People who have symptoms or are at risk for complications usually need to have surgery to correct entropion. Surgery tends to fix the condition immediately.

There are two main types of surgery used to treat entropion:

  • Eyelid tightening, which shortens the eyelid to make it tighter
  • Retractor insertion, which tightens the lid retractor—the muscle that opens and closes the eyelid

There are other procedures that eye doctors also may perform to treat entropion. Whichever procedure is used, topical anesthesia is typically placed on the eyelid to make sure that a person does not feel pain during the procedure.

Nonsurgical Options

If surgery is not an option, eye doctors may recommend other treatments to help a person who has entropion, including the following:

  • A small amount of Botox (botulinum toxin) can be applied to weaken the eyelid muscles; however, the treatment usually needs to be repeated every three to four months. Botox is especially helpful for spastic entropion.
  • A Quickert procedure involves placing two or three sutures to temporarily turn in the eyelid.
  • Medical tape can be used to change the eyelid position for a short time.

Prognosis

The prognosis for most cases of entropion is typically good. Once eyelid surgery is performed, a person's symptoms usually go away immediately and the condition does not come back.

The exception is cicatricial entropion, which can result in chronic inflammation and is more likely than the other types of entropion to return. According to the American Academy of Ophthalmology, the recurrence rate ranges from 12% to 71%.

Early diagnosis and treatment of entropion is key to preventing infection, a corneal scratch, or vision loss.

Coping

Each person with entropion will want to work with their eye doctor to determine which treatment is best for the type of entropion that they have.

Entropion does not always cause symptoms, but some people do experience discomfort. While waiting for surgery to permanently fix the problem, people can turn to treatments that can help ease their symptoms—such as eye ointments and artificial tears.

A Word From Verywell

There are several types of entropion—a condition in which the lids of one or both eyes turn inward and cause irritation and, in some cases, infection. Most people with the condition develop it as they get older due to age-related changes to the eye structures.

Surgery is the preferred way to treat most kinds of entropion. Once a person has surgery to fix the problem, any symptoms that they have will go away immediately and the condition usually does not come back.

Some people do not have symptoms; however, the longer a person delays treatment, the more likely they are to develop symptoms and complications, which can include vision loss.

Individuals should talk to their eye doctor about the best course of treatment for the type of entropion that they have. If they are waiting for surgery and have discomfort, there are treatments that can help ease their symptoms.

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Article Sources
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  1. The College of Optometrists. Entropion. Updated October 24, 2019.

  2. Cleveland Clinic. Entropion.

  3. American Academy of Ophthalmology. Involutional or Senile Entropion.

  4. American Academy of Ophthalmology. Spastic Entropion.

  5. American Academy of Ophthalmology. Cicatricial Entropion.

  6. American Academy of Ophthalmology. Congenital Entropion.

  7. American Academy of Ophthalmology. Eyelid surgery. Updated April 19, 2021.

  8. American Society of Ophthalmic Plastic & Reconstructive Surgery. Entropion.