What is entropion?
Entropion is a condition where the lower eyelid turns inwards or inverts towards the eye itself. This creates functional problems and visible asymmetries. Entropion is a condition that commonly affects the lower eyelid, causing eyelashes and skin to roll inside, and rub the eye. Constant rubbing of the turned in eyelid against the eye can lead to scratches called corneal abrasions as well as to recurrent infections, ulcerations and eventual compromise of vision.
What are the symptoms of entropion?
As the lower eyelid with the eyelashes turns inward, it rubs the eye. It can be constant, or the eyelid may periodically turn inwards when the eyes are tightly squeezed shut or with even each time you blink. Patients can experience a foreign body sensation, light sensitivity, tearing, burning and blurry vision. Severe eye abrasions may progress into ulcers that are prone to repeat infections that can lead to loss of vision.
What causes entropion?
There are many causes of entropion. It is important to be evaluated by a specialist to understand the exact cause:
Age. Entropion or inward rolling of the eyelid could be caused by age-related changes and loosening of the eyelid support. The lower eyelid is supported on each side by canthal tendons essentially like a hammock. Stretching of these supporting tendons can cause a sagging and loose eyelid. Some eyelids age in such a way that the inner support of the eyelid become more lax causing inward turning of the eyelid called entropion, as opposed to the outward turning of the eyelid called ectropion (link to ectropion article).
Prior surgery. Patients who have had previous eyelid or orbital surgery can develop lower eyelid malposition leading to inversion of the eyelid and entropion.
Trauma. Trauma to the inner lining of the lower eyelid can cause a tight scar band that pulls the eyelid inwards.
Infections. Repeat infections of the eye can cause scarring of the eyelid inner lining that may pull the eyelid inwards. Congenital. Rarely entropion is present at birth.
How is entropion diagnosed?
You may notice your eye feeling scratchy or have constant blinking and eye watering. You may notice that the eyelashes are turned towards the eye itself. If this occurs, you should see your doctor. A routing examination including a history and physical can be used to diagnose entropion. The history of the symptoms listed above can direct the physical exam. The doctor may perform an “eyelid distraction test” or a “snap-back test”, where they will pull on your lower eyelid and measure how far and how quickly the eyelid returns to the globe. A slow or incomplete return of the eyelid to the eye shows lower eyelid laxity that can contribute to entropion. The doctor will also have you close your eyes tightly to evaluate the tone and proper functioning of the eyelids. Photographs of the eyelids in open and closed position will be taken to monitor the eyelid position and are also required by most insurance companies. Your doctor may apply tape to the eyelid to help bring the eyelid outward. Entropion can cause scratches on the surface of the eye called corneal abrasions. Examination by an ophthalmologist will document the condition of the eye function and damage.
It is important to differentiate entropion from similar conditions in order to guide proper management. Specifically, trichiasis is a condition where eyelashes growth is misdirected inwards instead of outward, but the eyelid itself is normal. The symptoms are similar due to constant rubbing of the eye. Misdirected eyelash growth is treated by addressing the eyelashes rather than changing the eyelid position relative to the eye. Entropion is also different from a condition called epiblepharon where an additional fold in the lower eyelid pushes the eyelashes upward and they can touch and rub the eye. Generally, epiblepharon is minimally symptomatic and patients rarely require surgical treatment. It is important to see a specialist who can distinguish entropion from other conditions in order to guide proper treatment.
How is entropion treated?
Eye irritation can be medically treated with increased lubrication of the eyelid including over the counter natural tear drops and ophthalmic ointments. Taping the eyelid, so that it cannot roll inwards can help temporarily improve symptoms. Taping is especially useful while patients await surgical correction.
Mild entropion can be treated with a small amount of botulinum toxin (Botox, Xeomin, Dysport, Juveau) injections. Botulinum toxin can weaken the muscle that is tight and prevent the inwards rolling of the eyelid. Like all botulinum toxin treatments, the relief is temporary, and treatment would need to be repeated every 3-4 months. Alternatively, special sutures or laser resurfacing can be used for correction of mild entropion.
Moderate to severe entropion is treated surgically based on the laxity of the eyelids and its supporting structures. Loose tendons can be tightened and repositioned to restore normal eyelid shape and function. Some patients may require shortening and tightening procedures of the eyelid to repair entropion. If scar tissue from prior injury or surgery is contributing to entropion, grafting from the inner lining of the mouth can be needed to replace damaged tissue and return eyelid function. Your doctor can guide you through both medical and surgical options depending on the severity of your entropion.
The Surgeons of Norelle Health are highly trained and skilled in the diagnosis, management, and treatment of entropion. Dr. Araslanova can provide the optimal treatment for entropion. Moderate to severe entropion causing symptoms may be covered by your insurance although most insurances consider milder entropion to be cosmetic. Generally, the insurance plans do not cover minimally invasive options like botulinum toxin or laser treatments. Entropion correction can be combined with lower blepharoplasty. As out-of-network providers, we will check your benefits for you and let you know if there are costs are so there are no surprises. We use an individualized treatment plan for your concerns to provide a personalized holistic plan of care. If you would like assistance, please feel free to contact us.