Entropion – Inward turning of the eyelid
Entropion is a malposition of the eyelid, which turns inward. Your eyelashes and skin rub against the surface of the eye, causing irritation and discomfort. With entropion, the eyelid may turn inward permanently or only when blinking. Entropion primarily affects older people and almost exclusively the lower eyelid. Artificial tears and lubricating ointments can help relieve the irritation caused by entropion. Only surgery can correct this condition: the surgeon tightens and repositions the eyelid. If left untreated, entropion can damage the cornea, cause ulcers, eye infections, and irreversible vision loss.
What is entropion?
Entropion is a malposition of the eyelid that causes the eyelashes to rub against the eye.
It is most often linked to age and the loosening of skin tissues.
The eye is constantly attacked, irritated, and responds with reflex tearing.
Symptoms
The symptoms of entropion are those of eyelashes rubbing against the eye when blinking. You may experience the following symptoms:
Pruritus – Sensation of a foreign body.
Irritation and redness.
Tearing and secretions.
Pain – Increased when blinking and relieved when pulling on the eyelid.
Photophobia – Sensitivity to light.
Blepharospasm – Spasms of the eyelid and difficulty opening the eye.
When to consult a doctor?
In cases of chronic entropion symptoms and moderate symptoms, it is advisable to consult an eyelid specialist without urgency.
While waiting for the consultation, ask your pharmacist for artificial tears and a healing ointment (Vitamin A) to protect your eye.
If you leave entropion untreated for too long, it can cause permanent damage.
Signs of severity and urgency
The symptoms that should prompt an emergency consultation are:
Sudden redness or pain
Severe photophobia – Sensitivity to light
A decrease in visual acuity – Blurred vision.
These are signs and symptoms of a potentially serious corneal injury requiring urgent treatment.
Causes
Entropion can be caused by:
Muscle weakness – With age, the muscles under the eyes tend to weaken and the tendons to stretch. This is the most common cause of entropion. It is called senile entropion.
Spasm – Chronic eye irritation caused by dryness or inflammation can lead to spasm of the eyelid muscles (orbicularis oculi). This chronic spasm causes the eyelid margin to roll inward against the cornea: spasmodic entropion.
Previous scars or surgical procedures – A skin scar can distort the normal curvature of the eyelid and cause it to retract. This is called cicatricial entropion.
Eye infection – A chlamydial eye infection called trachoma is common in many developing countries. It causes scarring of the inner eyelid, with retraction of the conjunctiva and entropion. If left untreated, the disease leads to blindness.
Malformation – When entropion is present at birth (congenital), it can be caused by an abnormal skin fold on the eyelid that causes an inversion of the eyelashes towards the globe.
Risk factors
The factors that increase your risk of developing entropion are as follows:
Age – This is the primary cause of entropion, due to aging and tissue remodeling.
Burns or scars – If you have suffered a burn or other injury to the face, the resulting scar tissue can retract and invert the eyelid.
Trachoma – Chronic chlamydia infection – Because trachoma can leave scars inside the eyelids, people who have suffered from this infection are more likely to develop entropion.
Complications of entropion
Entropion causes the eyelashes to rub against the surface of the eye with each blink. This irritation of the cornea can lead to a painful ulcer.
If the ulcer is left untreated, it can become infected: this is called a corneal abscess. It can also deepen and lead to a perforation of the eye, which has a very poor prognosis.
Prevention
Entropion is generally unavoidable. However, trachoma screening and treatment campaigns in developing countries have drastically reduced the occurrence of scarring entropion in these countries. The rate of trachoma-related blindness has also plummeted.
Medical treatment
The treatment approach depends on the cause of your entropion. Non-surgical treatments are available to relieve symptoms and protect your eye from eyelash rubbing.
Surgery is usually required to completely correct entropion, but short-term solutions may be helpful if you cannot tolerate surgery or need to postpone it.
Comfort care
To relieve the symptoms of entropion until you can have surgery, you can use:
Lubricants, eye drops and eye ointments – Artificial tears and vitamin A ointment help to protect your cornea and keep it lubricated.
A support bandage or adhesive strip – A clear bandage can be applied under your lower eyelid to pull it down and prevent the edge from turning inward. Place one end of the bandage near your lower eyelashes, then gently pull it down and secure it to your cheek. Ask your doctor to show you the correct technique and placement of the bandage.
Medical care
Soft contact lenses – Your ophthalmologist may prescribe a soft contact lens to be used like a corneal patch to reduce friction. These lenses are available with or without a prescription.
Botox – Small amounts of botulinum toxin (Botox) injected into the lower eyelid can reduce spasms of the orbicularis oculi muscle and make the edge of your eyelid appear more prominent. The treatment's effectiveness is temporary (a few months) and can be repeated.
Entropion operation
Entropion surgery is performed on an outpatient basis, under local anesthesia of the eyelid. You will be discharged the same day as the operation after a few hours at the clinic.
Before the intervention
The surgeon performs a local anesthetic to numb your eyelid and the area around it.
The anesthesiologist may also inject a sedative to make you more detached.
During the operation
The entropion operation consists of repositioning the edge of the eyelid parallel to the surface of your eye.
He makes a small incision on the outer part of your eye and below the lash line.
The tendon supporting the eyelid is cut and tightened.
If necessary, the orbicularis oculi muscle is thinned.
The suture remains hidden under the eyelash line.
Case of cicatricial entropion
In the case of a scarring origin, the skin must be loosened by pulling the eyelid inwards.
The surgeon takes a flap of oral mucosa (inner surface of the lip).
He then grafts the mucous membrane onto your conjunctiva to restore its elasticity.
The eyelid support tendon is also repositioned.
After the operation
The surgeon will apply a dressing at the end of the procedure. You will remain under observation for a few minutes upon waking, then you can return to your room to eat before going home.
Once home, it is advisable to follow these guidelines:
Use an antibiotic ointment on your eye for a week.
Apply compresses or a cold mask to reduce bruising and swelling.
Post-operative care and convalescence
A rest period of approximately 1 week is recommended after the operation.
You will probably have:
Transient swelling of the eyelid.
Bruises on and around your eye.
Your eye will appear smaller after the procedure, with a tight palpebral fissure. This will normalize within a few weeks once the tissues have healed.
The stitches will be removed after 7 to 10 days.
The swelling will subside in about two weeks.
Side effects and complications of the operation
The side effects and complications of entropion correction are those usual in eyelid surgery:
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Bleeding and hematoma.
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Surgical site infection.
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Stitches came undone…