Entropion: causes, symptoms and treatment
Entropion is the ophthalmological disorder in which the eyelid of the eye turns inwards. It is different from ectropion, where the eyelid turns outwards. It most often occurs in older people and usually only affects the lower eyelid.
What is palpebral entropion?
Entropion, also known as “palpebral entropion”, is the eversion of the eyelid margin towards the ocular surface and cornea. In scientific terms, it is the pilosebaceous unit and the mucocutaneous junction that are reoriented towards the inside of the eye.
Entropion can occur:
- On the upper eyelid, lower eyelid, or both;
- In one or both eyes (in which case the patient experiences bilateral entropion);
- In both adults and children, but it is more common in the elderly.
Untreated, entropion can lead to:
- Corneal thinning;
- Corneal neovascularization;
- Corneal abrasion;
- Corneal lesions;
- Conjunctival lesions;
- Eye scars.
Entropion vs Epiblepharon
Entropion can be confused with epiblepharon.
Entropion can affect both the upper and lower eyelids and has to do with muscles and ligaments inside the eye, eye infections and injuries, or previous treatments.
Epiblepharon affects only the lower eyelid. The lashes curl inwards towards the eye because of an extra fold of skin on the lower eyelid of the eye.
What causes palpebral entropion?
Entropion can occur either because the eyelid muscles are weakened or because the ligaments that attach the eyelid to the walls of the eye socket are weakened. Another cause of entropion may be a scar on the tegument or conjunctival lining of the eye, which causes traction on the eyelid and causes the edge of the eyelid to bend inwards.
Risk factors:
- Old age;
- Agenesia – the eyelid does not have enough tissue developed (a congenital problem);
- Eye infections (e.g. granulomatous conjunctivitis);
- Ophthalmological treatments (entropion can occur as a reaction of the body in people who use a certain ointment to treat glaucoma).
How many types of entropion are there?
Depending on the cause of the disease, there are four types of entropion:
- Involutional entropion is the most common form of the disorder and occurs mainly in people over 60. This type is caused by low muscle tone, especially in the retractor muscles of the lower eyelid, which causes the lashes to bend towards the eyeball.
- Spastic atrophy occurs when the eye muscle contracts continuously and bends the edge of the eyelid inwards. This type of entropion is triggered by various irritations, inflammation or injuries, such as conjunctivitis, blepharitis or keratitis. Spastic entropion can also be caused by decreased posterior palpebral support, which results in the eyeball being placed deeply into the orbit.
- Cicatricial entropion can be caused by injury to the eye, eyelid burns, but also in case of adverse reactions to medicines or various disorders such as trachoma, viral conjunctivitis or blepharitis. This type of entropion affects and is manifested by curvature of the tarsus.
- Congenital entropion is a rare form that occurs at birth.
What are the symptoms of entropion?
Patients experiencing palpebral entropion may have different symptoms, depending on the stage and severity of the disease. It starts with a sensation of irritation in the affected eye, itching and the sensation of a foreign object in the eye. Over time, entropion causes increasing discomfort and the following appear:
- Aches and pains;
- Excessive tearing;
- Dry eyes;
- Sensitivity to light;
- Eye discharge and crusting (usually in the morning);
- Decreased quality of vision;
- The appearance of an extra layer of skin around the eye.
Severe cases of palpebral entropion can cause:
- Scars on the surface of the cornea;
- Corneal ulcer;
- In very rare cases, loss of vision.
How is palpebral entropion diagnosed?
Diagnosis of palpebral entropion is made during an ophthalmological examination. The doctor assesses tissue laxity and determines the location, type and severity of the entropion by pulling the eyelid towards the nose and temple. The patient may also be asked to blink or forcefully close their eyes.
This helps the ophthalmologist find out where the eyelid position is on the eye and what its muscle tone is. If the entropion is caused by scars, previous surgery or other ophthalmological disorders, the doctor will carry out further investigations to examine the surrounding tissues.
What is the treatment for entropion?
There are a number of treatments that only relieve the symptoms of palpebral entropion for a short time. These include:
- Ophthalmic drops for lubricating the eyeball;
- Contact lenses;
- Injectable treatment.
The definitive treatment is entropion surgery.
The surgery aims to reposition the eyelid and improve muscle tone in the affected eye. The procedure involves administering local anesthesia by injecting lidocaine into the eyelid tissues in combination with soothing and analgesic medication.
The technique used by the specialist differs from one type of disorder to another. Usually, entropion surgery consists of strengthening the structure of the eyelids by resecting whole pieces of eyelid or sections of skin and muscle. A procedure to strengthen the lateral ligaments (a canthoplasty) may also be performed. If there is a scar on the skin or conjunctiva, the surgeon will excise the scar and place a skin graft. This may be taken from behind the ear, from the upper eyelid, from the roof of the mouth or from the nasal passages.
Complications
Very rarely, complications can occur following entropion surgery. These include:
- Hypertrophic scars;
- Eye infections;
- Hematoma;
- Ectropion.
Postoperative recommendations
Entropion surgery is performed on an outpatient basis. After the surgery is completed, a dressing is applied and the patient can go home. The following day, the patient returns to the clinic for the dressing to be removed. The sutures are removed 5-7 days after surgery.
To prevent infection, the specialist doctor may prescribe antibiotics and anti-inflammatories. The patient may be given medication consisting of artificial tears, antibiotics, corticosteroids, botulinum toxin or a systemic chemotherapy. Cold compresses to the operated area may also be recommended. Aspirins are not indicated as they may increase the risk of bleeding.
If you notice symptoms of entropion in yourself or a loved one, make an appointment for a specialist examination. The Dr. Holhoș ophthalmology network awaits you with state-of-the-art services and equipment in Cluj-Napoca, Sibiu, Mediaș, Turda and Alba-Iulia clinics.
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