What Is Entropion?

Date: Aug-13-2012Entropion is a medical eye condition in which the eyelid folds inwards, usually the lower eyelid, but the condition also exists with the upper eyelid. The patient's eyelashes and skin rub against the cornea of the eye, causing watery eye, inflammation, discomfort, irritation and sometimes pain. Some entropion patients have their eyelid turned in permanently, while for others it only occurs when they shut their eyelids tightly or blink hard.

Entropion is commonly due to a person's genetic makeup; in some rare cases, the lower eyelid may have an extra fold of skin. Some patients may have bilateral entropion, when both eyes are affected.

In mild cases eye drops may be the only treatment necessary. In severe cases there can be extreme pain and loss of vision. If there is a lot of irritation, a corneal ulcer may develop and become infected. If the condition is causing a risk to the health of the eye, the doctor may recommend surgery.

Entropion is very rare in children and young adults, and typically occurs in patients over the age of 60 years.

According to Medilexicon's medical dictionary, Entropion is:

"1. Inversion or turning inward of a part.

2. The infolding of the margin of an eyelid."
What are the signs and symptoms of entropion?
A symptom is something the patient feels and describes to others, such as pain or itchiness, while a sign is something others can detect as well, such as redness or swelling. The signs and symptoms of entropion are caused by the eyelashes and eyelid skin rubbing against the surface of the eye.

Entropion signs and symptoms may include:
A strange sensation in the eye, as if there is something stuck in it
Excessive tearing onto the face (epiphora)
Eyelid crusting, or eye mucous discharge
Irritation in the eye
Pain in the eye
Photophobia (the eye is sensitive to light
The eye is very sensitive to wind
The skin around the eye sags
The whites of the eyes become red
Vision problems, especially if there is damage to the cornea

What are the causes of entropion?

Aging - as we get older there is more loose skin around the eyelids, the muscles under the eyes weaken, and the tendons and ligaments relax more.

Scarring - scarred skin may be caused by trauma, surgery, radiation to the face, or chemical burns. Scarring can alter the normal curvature of the eyelid.

Infections - trachoma, an infectious disease caused by the bacterium Chalmydia trachomatis can cause the inner surface of the eyelids to become rough and scar. The infection is uncommon in developed nations, but affects tens of millions of people globally.

Spasm - eye surgery, for example, can result in spasms in the eyelid, which can cause it to fold inwards.

Congenital - in some rare cases, entropion is present when the baby is born.

How is entropion diagnosed?
A GP can usually diagnose entropion easily with a routine physical examination of the eye, this may involve pulling on the eyelids, asking the patients to close his/her eyes tightly or blink hard. Special diagnostic tests are not usually required.







In cases where the condition is suspected to have been caused by scar tissue or a previous surgical intervention, the doctor will also check the surrounding tissue.

It is important for the doctor to know why the entropion occurred, as this helps choose the most effective treatment.
What are the treatment options for entropion?
If symptoms are mild, the doctor may simply prescribe eyedrops to sooth some of the symptoms. In most other cases the patient will probably require surgery.

Infection and/or active inflammation - often, after an infection and/or inflammation has been successfully treated, the eyelid stops folding inwards and returns to its normal position. Unfortunately, this does not always happen and the eyelid still causes problems.

If surgery is not possible at that moment, or if the patient does not want to undergo surgery, the following temporary treatments may help:

Transparent skin tape - this is stuck to the eyelid to stop it from folding inwards. One end is placed near the lower eyelashes while the other is stuck to the upper cheek. It is important that the medical staff teach the patient how to do this properly.

Special stitches - up to three stitches are placed along the eyelid, which force it to turn outward. Even after the stitches are removed, the eyelid is usually kept in its normal position for a several months. This can be done at a doctor's office with local anesthesia. Experts stress that although effective, this solution is just a temporary one.

Botox (OnabotulinumtoxinA) - the doctor injects some Botox into the lower eyelid, which usually forces it to turn outwards. A series of injections are required. The positive effects are temporary, and will not last more than six months. Patients with temporary entropion may prefer this procedure, because by the time the Botox's effects have gone, so has the temporary entropion.

Surgery

There are several effective types of surgery available for treating entropion. Which one the doctors recommends, depends on several factors, including what is causing it, the state of the surrounding tissue, the patient's age and overall health, etc.

Aging - if the entropion is the result of muscle, ligament and tendon relaxation, which is caused by age, the surgeon will take out a tiny part of the lower eyelid, thus making the tendons and muscles tighten. The patient will come out of the procedure with some stitches either on the outside corner of the eye, or just under the (lower) eyelid.

Scar tissue - if the condition is caused by scar tissue or a previous surgical procedure, the surgeon may take some skin from either behind the ear or the upper eyelid and graft it onto the lower eyelid.

After either procedure, the patient will have to wear an eyepatch for approximately 24 hours. Antibiotics will be prescribed to protect against post-surgical injections, as will steroids to prevent inflammation. Acetaminophen (Tylenol, paracetamol) may help alleviate discomfort and swelling. Some patients find that applying a cold compress gently to the area may also help.

Within about 7 days the stitches are removed. Over half of all patients say they experience symptom relief straight after their operation.
What are the possible complications associated with entropion?
The cornea can become irritated and damaged. A corneal ulcer may also develop, which can become infected and lead to severe loss of vision if not treated promptly.

Corneal abrasions may also occur - there is loss of the surface of the epithelial layer of the cornea.

Lubricating ointments and eyedrops can help reduce the irritating and damaging effects of having the eyelashes and outer skin of the eyelid rubbing and scratching against the eye until surgery is done.

Written by Christian Nordqvist

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