What is entropion?
Entropion is a condition where the lower eyelid turns inwards towards the eyeball. It often comes and goes at first but can become permanent. Because the eyelashes are also turned in, the eye can be scratched by the eyelashes.
What causes entropion?
The most common reasons for entropion developing are:
- Increasing age: the eyelid loses its elasticity and tone and a very tiny muscle in the lower eyelid (the lower eyelid retractor) becomes loose, making the eyelid unstable. The lid may turn inwards (entropion) or outwards (ectropion) when this happens.
- Scarring inside the eyelid: occasionally, scarring conditions of the lining of the eyelid (the conjunctiva) may lead to entropion.
What are the symptoms of entropion?
The symptoms from entropion of the lower eyelid can include the following:
- Watery eye: eyelashes irritate the surface of the eye and cause watering.
- Soreness of the eye: the eyelashes scratch the surface of the eye.
- Redness of the eye: caused by the irritation.
- Discharge from the eye: the eye will often produce more tears and mucus when there is entropion present.
- Corneal ulcer: in rare cases, the front surface of the eye (the cornea) can develop an ulcer which can be very serious for the health of the eye. Corneal ulcers are more common when entropion is present.
How is entropion treated?
Entropion is usually treated by surgery; it is not considered major surgery. Sometimes other forms of treatment may be used to temporarily correct the entropion including:
- Tape can be carefully placed to stop the eyelid turning in. After being shown how to do this correctly by your doctor, the tape must be applied very carefully to avoid the tape scratching your eye.
- Botox injections can be helpful for some weeks while an operation is organised.
- Temporary stitches in the eyelid may be effective for several months. This procedure can often be performed in your doctor’s rooms.
The cause of the entropion will determine the type of operation required. In most cases the eyelid will be ‘tightened’, usually by making a very small incision at the outer corner of the eye and pulling the eyelid across to reattach it just inside the rim of the bony eye socket at the outer corner (this is sometimes called a ‘tarsal strip’ operation).
In combination with this, there may be other procedures performed. These can include the following:
- Repairing the lower eyelid retractors. This is usually done through an incision just under the eyelashes which heals very well and does not leave a noticeable scar.
- Stitches through the eyelid to help turn it outwards.
What sort of anaesthetic will be used?
Nearly all entropion operations are performed with a local anaesthetic. Before any local anaesthetic is injected into the skin of the eyelid, your anaesthetist will give you some medicine in the form of a sedative and pain killer so that the eyelid injection will not be painful. Often it is not even noticed or remembered. During the operation, you will be aware that the eyelid is being operated on but it will not be painful. It is important for you to say if there is any pain during the operation.
How long will I stay in hospital?
Most patients having entropion surgery can go home on the day of surgery, but a few are kept in overnight after the operation. You will be told at the time the surgery is booked how long you will stay in hospital.
What problems can occur with entropion surgery?
Nearly all entropion operations are successful, but occasionally problems may occur. These include the following:
- Failure to fully correct the entropion: this is rare, and another operation may be needed.
- Scarring: there is always a small scar at the outer corner of the eye where the eyelid is tightened, but this fades over 2 to 3 months and is very rarely noticeable after that time. The scar under the eyelashes fades very quickly.
- Recurrence: as the skin continues to gradually lose elasticity over time, the entropion may reoccur.
- Infection: while very rare with eyelid surgery, if an infection occurs, it can be treated with antibiotics.
- Bleeding: a little bleeding in the first 24 hours is common. Occasionally, there may be more significant bleeding 5 to 10 days after surgery, usually from the outer corner of the eye. If this happens, clean the eye by folding several tissues together. Then close the eye and hold the tissues firmly over the area that is bleeding (or the whole eye if you are not sure) for 10 minutes. Repeat a second time if this does not help.
Follow up care
After you are discharged from hospital, you will usually be seen again in the clinic after about a week, and sometimes, again about 2 to 3 months after the surgery for a final check-up.
During the first week or two, you will apply ointment to the eyelid wound and sometimes also lubricating drops, gels or ointments.
Pain is usually mild after entropion surgery and strong pain killers are very rarely needed. The eyelid(s) are usually bruised and swollen for 1 to 2 weeks only.
While you still have stitches do not let the shower run onto the eye. Instead, wash with sterile water or saline solution.