Entropion Surgery

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What is Entropion (Eyelid Turning in)?

Entropion is a condition in which your eyelid turns inward.(1) This means that your eyelashes and skin rub against your eye’s surface, which can cause irritation and be uncomfortable. Entropion may cause your eyelid to turn in at all times. Or it may only happen when you squeeze your eyelids shut or blink very hard.

While entropion is rare in children, it does happen in some adults. According to the American Academy of Ophthalmology, entropion occurs in up to 2.1 percent of people who are over the age of 60.(2)

Fortunately, there are treatments to ease the discomfort associated with entropion. For example, artificial tears, certain lubricants, taping, and botulinum toxin injections (botox) can help to temporarily relieve some of the symptoms.

Entropion repair surgery is generally necessary to restore the anatomic positioning and truly correct entropion. If left untreated without eyelid surgery, entropion can lead to irritation of the ocular surface, infections of the cornea, and even vision loss.

Causes of Entropion

Entropion can happen to anyone for a variety of reasons. 

Aging alone can cause entropion.(5) As you get older, the skin around your upper eyelid starts to loosen, and the muscles under the eye start to weaken. The tendons and ligaments in the area also relax. This can cause a number of eye conditions, like entropion.

Scar tissue can also be a cause.(5) Scarring of the skin can cause the eyelids to turn inward. Scarring may be a result of trauma, a previous surgery, radiation, chemical burns, or a whole host of reasons.

Bacterial infections, like trachoma, can also affect the eyes and cause entropion.(5) Trachoma, for example, can cause the inner surface of the eyelids to roughen up and scar. This can distort their shape and the way they close.

Congenital issues may also be at the root of entropion, though this is rare.(5)

Symptoms of Entropion

Some of the symptoms associated with entropion include, but are not limited to, the following:

  • Vision problems
  • Eye infections
  • Corneal ulcers
  • Corneal abrasions
  • Irritation on the surface of the eye and around the eyes
  • Red eyes
  • Dry eye
  • Eyelid pain
  • Excessive tearing (epiphora or mucous discharge)
  • Sensitivity to light (photophobia)
  • Sensitivity to wind
  • Sagging eyelid skin

What are the Risk Factors for Entropion?

Age, previous eye surgeries, and bacterial infections put you at a higher risk for entropion. As you get older and the skin around your eyes begins to sag, it can change the way your eyelids shut. Surgery and infections can do the same due to scar tissue.

Entropion vs Ectropion

While your eyelids turn in with eyelid entropion, ectropion is a little different. Ectropion is a condition in which your eyelid turns outward instead.(4) It generally affects the lower eyelid. Ectropian leaves the underside of your eyelid exposed and, therefore, prone to irritation and infection. It also leaves your eyeball itself more open. 

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As with entropion, ectropion is largely an age-related condition.(3) Similarly, there are some ways that you can treat the symptoms of ectropion. But reconstructive surgery to fix your eyelids is the only way to permanently repair the problem.

How is Entropion Diagnosed?

Only a physician or an eye doctor can diagnose entropion with a routine eye exam. They may determine that you have entropion by pulling on your eyelid and asking you to close your eyes, squeeze them shut, and blink hard. They may also use diagnostic tests, though these are generally not necessary.

How is Entropion Treated?

Entropion can only be fixed with surgery. That said, you may use a number of treatments to get temporary relief. 

For example, eye drops and lubricants can help keep your eyes moist and clean out bacteria. Taping and botox can also help to lift the sagging skin around your eyes, so that your eyelids shut properly. 

What is Entropion Surgery? 

Entropion surgery is the only way to permanently fix entropion. Talk to your doctor about what type of entropion surgery is right for you.

People who may need entropion surgery include those who have sagging skin around their eyes due to age or previous surgeries. Other people who may need entropion surgery are those who have scar tissue around their eyes or who have had bacterial infections that caused entropion.

Some people are born with congenital entropion. These people also make good candidates for entropion surgery, though there are fewer of them.

Types of Entropion Surgery

There are a few different types of entropion surgery.

Entropion surgery usually involves the Quickert procedure, which entails everting sutures. This is a fast, minimally invasive, and generally low-cost way to fix entropion. Another surgical procedure involves tightening the lower eyelid laxity. The doctor may also choose to do a combination of both.

How Does Entropion Surgery Work?

Entropion surgery works by surgically putting the eyelid back into its correct position. Your doctor will likely administer a local anesthetic in the subciliary skin and palpebral conjunctiva.(7) From there, your doctor will insert a double-armed absorbable suture into the conjunctival fornix (with the Quickert procedure).(2)

Exploration and reinsertion of the lower lid retractor can also be done. In this case, they may make an external incision or an internal transconjunctival approach.(2)

In another procedure called lateral canthal tightening, the surgeon will isolate the tarsus from the anterior and posterior lamella. They’ll shorten it and then reattach it to the periosteum of the lateral orbital rim.(2)

While these sound like intense procedures, they are very short. Entropion surgery can be done in a day and the recovery period is rather short. However, it may take a few weeks to a few months for the appearance of your eyes to fully recover. 

While it may take some time for your eyes to look better, entropion surgery is worth it for people with severe cases. Leaving your eyes untreated can lead to bigger problems down the line. Forgoing entropion surgery can even result in vision loss.

Alternative Therapies for Entropion

Here are some alternative therapies to temporarily relieve the symptoms of entropion:

Soft Contact Lenses

Soft contact lenses may be a better option than hard ones for people with entropion. If you need to wear contacts, these can be more comfortable — especially if you already experience irritation. 

Since entropion can already cause dry eyes, you may want to use a recommended eye drop with your contacts, too.

Botox

Botox can help to keep your eyelid in place by freezing the muscles around your eyes. Botox injections are easy and last a few months. You may only need to be topped up every few months or even just once a year.

Stitches

Stitches can also treat entropion. Your doctor may use two or three stitches in your eyelid to return it to a normal position.

Skin Tape

Skin tape lifts any sagging skin and pulls it away from the eye. This can help keep your eyelid in place. Skin tape is only a temporary solution, however.

What is the Prognosis for Patients with Entropion?

Most people who have entropion and take care of it sooner rather than later have a fairly good prognosis. Surgery usually resolves the problem. And entropion rarely returns after surgery is done. It’s generally a permanent solution. Though some situations can cause entropion to occur again, such as scarring from new surgeries and bacterial infections.

That said, the sooner you treat entropion, the better your chances are of fixing it before too much damage is done. And the better your chances are at maintaining healthy eyes and good vision.

Talk to your doctor about whether or not entropion (or ectropion) surgery is right for you. Your doctor will also be able to provide you with recommended treatments to ease some of your symptoms until you decide on a permanent solution. The choice is yours!

Resources
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Bergstrom, Reece. “Entropion Eyelid Reconstruction.” StatPearls [Internet]., U.S. National Library of Medicine, 22 Feb. 2021, www.ncbi.nlm.nih.gov/books/NBK470540/

“Diagnosis and Management of Involutional Entropion.” American Academy of Ophthalmology, 25 Jan. 2016, www.aao.org/eyenet/article/diagnosis-management-of-involutional-entropion.

“Ectropion.” Mayo Clinic, Mayo Foundation for Medical Education and Research, 5 Jan. 2021, www.mayoclinic.org/diseases-conditions/ectropion/diagnosis-treatment/drc-20351169.

“Ectropion.” Mayo Clinic, Mayo Foundation for Medical Education and Research, 5 Jan. 2021, www.mayoclinic.org/diseases-conditions/ectropion/symptoms-causes/syc-20351164#.

“Entropion.” Mayo Clinic, Mayo Foundation for Medical Education and Research, 14 Jan. 2021, www.mayoclinic.org/diseases-conditions/entropion/diagnosis-treatment/drc-20351131.

“Entropion.” Mayo Clinic, Mayo Foundation for Medical Education and Research, 14 Jan. 2021, www.mayoclinic.org/diseases-conditions/entropion/symptoms-causes/syc-20351125.

Lee, Seunghyun, and Helen Lew. “A 2-Step Procedure for Entropion Treatment: Eyelid Splitting and Full-Thickness Everting Sutures.” Plastic and Reconstructive Surgery. Global Open, Lippincott Williams & Wilkins, 9 Dec. 2020, www.ncbi.nlm.nih.gov/pmc/articles/PMC7787272/.

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