A Simple Guide to Entropion

A Simple Guide to Entropion
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What is Entropion?
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Entropion is an inversion(rolling inwards) of the eyelid

Who is affected by Entropion?
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Entropion is more common in women than in men.


What is the Cause of Entropion?
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The causes of Entropion can divided into 2 type:

Spasm of Orbicularis muscle:

1. Degeneration of the peripheral connective tissue of the eye

2. Occurs in old age

3. Occurs also after removal of eyeball

4. Primarily affects the lower eyelid.

Cicatricial:

1. Scarring of the eyelid muscle to connective tissue as a result of injury, trauma, burns

2.retraction of the connective tissue of eyelid from infections such as trachoma, chronic infections

3.Congenital disease

4. May affect either upper or lower eyelid

What are the Symptoms and signs of Entropion?
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Symptoms varies from mild to severe due to rubbing of eyelashes against the cornea or conjunctiva:

1.Irritation of the conjunctiva

2.Conjunctival congestion - increased blood flow through irritated eye shows up the blood vessels

3.Tearing -excess tears from irritation

Signs:

1.Erosions, opacities and vasculisation of the cornea

2.increased dilated blood vessels of conjunctiva present due to irritation

3.The presence of inward turning eyelids and eyelashes


How do you make the Diagnosis of Entropion?
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The presence of inward direction of the eyelashes and eyelid can be seen using a slit lamp microscope.

What are the complications of Entropion?
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1.Recurrent corneal ulcers

2.Recurrent irritation and conjunctivitis of eyes.

3.Severe infection of the eye - rare

What is the treatment of Entropion?
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Treatment depends on the type of Entropion:

Spastic:

1.Eversion of eyelid especially lower eyelid with adhesive plaster or tape for temporary relief together with lubricating eye
drops

2.Surgery - by removal of inturning eyelashes using laser
- eversion of eyelid by surgery as below

Cicatricial:

Surgery to tighten the eyelid muscle is usually required:

1.Quickert procedure: 2 to 3 strategically placed stitches are used under local anesthesia to evert the eyelid.

Recurrence is common.

This is useful for patients who are not suitable for surgery and can be followed the full repair surgery later on when the patient is better.

2.Repair of inverted eyelid is done by incision above and below the eyelids and removal of connective tissue or scarred tissue and tightening of the eyelid muscle.

This is usually done on an outpatient basis and under local anesthesia.

Post-operatively the wounds are protected by antibiotic creams and dressings.

Healing usually occurs within 1 week.

Antibiotics are also given for any infections of the conjunctiva and cornea.



What is the prognosis of Entropion?
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The prognosis is usually good.

Recurrence is rare but do occur especially due to weakening of eye muscles from age.