What Is Entropion?

Entropion occurs when the eyelid edge rotates inward toward the eye. This causes the lashes and lid skin to contact the cornea (the clear front surface of the eye) and the conjunctiva directly. The constant friction produces irritation, redness, tearing, and if untreated, can lead to corneal abrasion, ulceration, and scarring.

The condition predominantly affects the lower eyelid. Upper lid entropion is less common and is usually associated with cicatricial (scarring) causes.

Types and Causes

Involutional (age-related) entropion

The most prevalent form. Aging weakens the structures that maintain lid position -- the lower lid retractors, tarsal plate, and canthal tendons become lax. Overriding contraction of the orbicularis muscle tips the lid margin inward.

Cicatricial (scarring) entropion

Scar tissue on the inner surface of the lid (conjunctiva and tarsus) pulls the lid margin inward. Causes include chronic inflammation, chemical burns, trachoma, autoimmune conditions (ocular cicatricial pemphigoid, Stevens-Johnson syndrome), and previous surgery.

Spastic entropion

Reflex spasm of the orbicularis muscle, triggered by ocular irritation, infection, or recent surgery, temporarily turns the lid inward. It often resolves when the underlying cause is treated, but may predispose to involutional entropion.

Congenital entropion

Rare. Results from a developmental abnormality of the tarsal plate. Usually affects the lower lid and may resolve spontaneously; surgical correction is needed if it persists.

Symptoms

• Redness and tearing of the eye
• Stinging, burning, and foreign body sensation
• Visible inward turning of the lid margin
• Light sensitivity (photophobia)
• Blurred vision (due to corneal irritation)
• Mucoid or mucopurulent discharge (in chronic cases)
• Palpable lash contact against the eye surface

Corneal Damage Risk

The most serious complication of entropion is corneal injury. Persistent lash rubbing erodes the corneal epithelium. If untreated:

• Corneal ulcer may develop (risk of secondary infection)
• Corneal scarring may cause permanent vision reduction
• Corneal perforation may occur in severe cases (rare, constitutes an emergency)

Entropion is therefore not just a source of discomfort -- it is a condition that can threaten sight if left unaddressed.

Diagnosis

Diagnosis is clinical. The examination includes assessment of lid margin position and lash-cornea contact, snap-back and distraction tests to evaluate lid laxity, fluorescein staining to identify corneal epithelial damage, conjunctival examination for scarring (to distinguish cicatricial from involutional types), and investigation of any underlying systemic cause.

Treatment

Temporary measures

• Taping: The lid is taped outward to keep lashes away from the cornea.
• Botulinum toxin: Injection into the orbicularis muscle reduces spasm and can temporarily evert the lid for two to three months.
• Artificial tears and gel: Protect and lubricate the ocular surface.

These measures are bridges to surgery, not permanent solutions.

Surgical correction

• Retractor repair and lid tightening: The standard approach for involutional entropion. The lower lid retractors are reattached and the lid is tightened horizontally.
• Everting sutures: A simpler technique placing sutures that rotate the lid outward. Suitable for mild or temporary cases; higher recurrence rate.
• Lateral tarsal strip: Tightens the outer corner of the lid by shortening the tarsal plate attachment, correcting horizontal laxity.
• Posterior lamellar repair: For cicatricial entropion. Scar tissue is released and a mucous membrane graft (buccal mucosa or amniotic membrane) may be placed to reconstruct the inner lid surface.

Recovery