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Eyelid Turning In (Entropian)

What is an Entropion?
An entropion is a degenerative condition that causes the eyelid to rotate inward (Figure 5). This can be congenital in nature, which means you are born with it. Congenital entropion is rare. More commonly, entropion occurs in the aging eyelid. I like to call this involutional entropion. Most people with involutional entropion are over the age of 65. Entropion can occur in the upper eyelid but most of the time involves the lower eyelid. Entropion can involve one eyelid or two (Figure 6).

What causes an entropion?
Since most cases of entropion involve the lower eyelid in our older population, my discussion will be restricted to this category.

If you think about a hammock that is suspended at its’ two ends, the lower eyelid is very similar. The inner end and outer end of the lower eyelid are attached to the nasal bone (inner) and orbital bone (outer), just like a hammock. This allows the eyelid to rotate, just like a hammock. If you have ever tried getting into a hammock, you know how easy it rotates. During youth, the eyelid is firm enough to resist this rotation and stays in place. As we age, however, the lower eyelid tissues become more lax and stretch. This allows the eyelid to easily rotate. An entropion results when the particular stabilizing structures of the eyelid undergo this aging/degenerative process.

Why doesn’t everyone over the age of 65 develop an entropion?
As long as the structures required for stabilization remain intact, an entropion will not develop. There is no way to predict who will develop an entropion.

Are there any other medical conditions that predispose one to the development of an entropion, like diabetes or hypertension?
Not to my knowledge

What are the symptoms of a lower eyelid entropion?
The most common symptoms of a lower eyelid entropion are redness and a scratchy eye. This is a very uncomfortable condition. Just think about how painful it can be having one eyelash stuck in the eye. With an entropion, the whole row of lower lashes is hitting the eye.
Most patients with entropion are not aware the eyelid is turning in. They just know there eye is irritated and always feels like “something is in it”. If the eye gets scratched, an infection can ensue.
Most of the patients I see for this condition are referred in by other physicians because of my expertise in this field.

What can be done to correct an entropion?
Entropion correction requires surgery. Rarely I have used BOTOX as a treatment for entropion. This is, however, only a temporary measure. There is no medicine that fixes this problem.

Can you tell me about the surgery?
Surgery is done in an outpatient setting under local anesthesia. It usually takes about 30 minutes for the entire procedure. Sedation is administered so you are very comfortable and don’t feel anything. The eyelid weakness is repaired and stabilized. Frequently the eye is patched overnight. The patch is removed the following day and ointment is used. Most patients return to their normal activity the next day.

Are there any complications from the surgery?
Like any surgery, there can be complications. The two most common complications are bleeding and infection. Fortunately, infection is uncommon. Bleeding causes “black and blue” resulting in a “black eye”. This “shiner” disappears in one to two weeks and has no adverse effect on the outcome of the surgery.

Can an entropion come back after surgery is done?
I have a 95% success rate correcting entropion. One can not predict who will recur or who will need more than one procedure. Fortunately, in my hands, this doesn’t happen too often.

Are there any other eyelid conditions that cause the eyelashes to rub against the eye?
The three most common lash problems include cicatricial entropion, trichiasis, and acquired distichiasis. These conditions usually result from eyelid inflammation that causes scarring within the eyelid (figure). These eyelash disorders can be managed either by (1) repeated epilation (pulling the eyelashes out in the office), (2) destruction or removal of offending lashes and their follicles (electrolysis or cryo/freezing), or (3) surgical alteration of the eyelid.

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