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Entropion – Everything You Need to Know

What is Entropion?

Entropion is a condition in which the eyelid (most often the lower lid) turns inward toward the eye. The inward‑folded lid forces the eyelashes and skin against the surface of the globe, leading to irritation, scratching, and potential damage to the cornea. It can affect one eye or both, and while it is more common in older adults, children can develop congenital (present at birth) forms as well.

In medical terminology, “entropion” comes from the Greek words en‑ (in) and tropos (turn). The opposite condition, where the lid turns outward, is called ectropion.

Common Causes

Entropion is usually the result of structural changes or disease processes that affect the eyelid’s supporting tissues. The most frequent causes include:

• Age‑related tissue laxity – loss of elasticity in the tarsal plate and canthal tendons.
• Congenital malformation – abnormal development of the eyelid muscles or connective tissue in infants.
• Scarring (cicatricial)** – from trauma, burns, or previous eye surgery that shortens the inner lid margin.
• Facial nerve (VII) palsy – weakness of the orbicularis oculi muscle can allow the lid to flip inward.
• Blepharitis – chronic inflammation of the eyelid margin that may cause lid malposition.
• Skin conditions – such as severe eczema, psoriasis, or ocular rosacea that thicken and contract skin.
• Tumors – benign or malignant growths on the lid can mechanically pull the margin inward.
• Systemic diseases – conditions like Graves’ disease (thyroid eye disease) or connective‑tissue disorders (e.g., Marfan syndrome) that alter tissue tension.
• Previous eyelid surgery – over‑correction of ectropion or blepharoplasty can unintentionally lead to entropion.
• Trauma – blunt or penetrating injuries that disrupt the eyelid’s anchoring structures.

Associated Symptoms

Because the eyelashes rub against the cornea, patients with entropion often notice a cluster of related complaints:

• Persistent eye irritation or a gritty sensation (“something in the eye”).
• Redness of the conjunctiva (the clear membrane covering the white of the eye).
• Excessive tearing (epiphora) as the eye tries to flush out irritants.
• Frequent blinking or involuntary eye‑closing (blepharospasm).
• Corneal abrasions or ulcers that may cause pain, light sensitivity, and blurred vision.
• Visible misalignment of the lid margin, sometimes with the lashes appearing to “kiss” the eye.
• Feeling of foreign‑body sensation, especially after waking up.

When to See a Doctor

Although mild entropion can be uncomfortable, it seldom requires emergency care. However, you should schedule an ophthalmology or optometry appointment promptly if you notice any of the following:

• New‑onset or worsening irritation that does not improve with lubricating eye drops.
• Persistent redness or swelling of the eyelid.
• Visible scratches on the cornea (often seen as a “white spot” on the eye).
• Decreased visual sharpness that does not resolve after rest.
• Development of a discharge that is yellow or green, suggesting infection.
• Difficulty keeping the eye open due to pain or spasms.

Prompt evaluation can prevent long‑term corneal scarring, which might lead to permanent vision loss.

Diagnosis

Eye specialists use a combination of history‑taking, physical examination, and sometimes imaging to confirm entropion:

1. Medical history – Questions about symptom onset, prior eye surgeries, trauma, systemic illnesses, and family history of eyelid disorders.
2. External eye inspection – The doctor will look for inward‑turned lids, trichiasis (misdirected eyelashes), skin changes, and signs of infection.
3. Fluorescein staining – A special dye highlights corneal abrasions or ulcerations under a cobalt‑blue light.
4. Eyelid eversion – The lid is gently flipped outward to assess the position of the lid margin and the health of the conjunctiva.
5. Schirmer test (if dry eye is suspected) – Measures tear production, because dry eyes can worsen symptoms.
6. Imaging (rarely needed) – High‑resolution MRI or CT may be ordered if a tumor or deep orbital pathology is suspected.

Treatment Options

Management depends on the underlying cause, severity of symptoms, and the patient’s age and overall health. Options are broadly divided into conservative (medical/home) measures and surgical correction.

Medical / Non‑Surgical Management

• Lubricating eye drops or ointments – Artificial tears (e.g., Refresh, Systane) keep the cornea moist, reducing friction.
• Topical antibiotics – Prescribed if there’s a secondary bacterial infection from corneal abrasion.
• Topical steroid eye drops – Short courses can reduce inflammation and swelling of the lid margin.
• Eyelash trimming or epilation – Removing misdirected lashes can provide temporary relief, especially in mild cases.
• Botulinum toxin (Botox) injections – In selected patients with facial nerve palsy, Botox can temporarily relax over‑active muscle forces that pull the lid inward.
• Taping or “pinching” devices – Small orthopedic‑type taping strips can hold the lid in a more neutral position for a few weeks while planning surgery.

These measures are generally palliative; they do not correct the anatomic defect and are often used while awaiting definitive surgery.

Surgical Treatment

When entropion interferes with vision or causes corneal damage, surgery is the definitive therapy. The specific technique is chosen based on the cause:

• Lateral tarsal strip procedure – Tightens the lower lid by shortening and re‑anchoring the lateral canthal tendon; often used for age‑related laxity.
• Re‑section of excess skin or orbicularis muscle – Removes redundant tissue that pushes the lid inward.
• Full‑thickness lid rotation (everting sutures) – Sutures placed through the lid margin rotate the lid outward.
• Conjunctival recession (Miller procedure) – Adjusts the inner attachment of the lid to the globe, useful for cicatricial entropion.
• Correction of facial nerve palsy – Tendon transfer (e.g., temporalis fascia sling) restores proper lid tension.
• Removal of tumors or scar tissue – Excision followed by reconstruction restores normal lid position.

Most surgeries are performed under local anesthesia with sedation, and patients can usually return home the same day. Recovery time ranges from a few days to two weeks, during which lubricating drops and protective shields are recommended.

Prevention Tips

While some causes (genetics, trauma) are unavoidable, many risk factors can be mitigated:

• Protect your eyes – Wear safety goggles when doing yard work, sports, or any activity with a risk of eye injury.
• Manage chronic skin conditions – Keep eyelid skin moisturized and treat blepharitis promptly with good lid hygiene (warm compresses, lid scrubs).
• Control systemic diseases – Adequate treatment for thyroid disease, diabetes, and connective‑tissue disorders helps maintain normal tissue elasticity.
• Avoid smoking – Smoking accelerates collagen breakdown, increasing lid laxity.
• Regular eye examinations – Early detection of subtle lid malposition allows for non‑surgical interventions before corneal damage occurs.
• Use protective eye shields after surgery – Following eyelid surgery, protect the area from rubbing or accidental trauma.

Emergency Warning Signs

Key Take‑aways

Entropion is an inward‑turning eyelid that can cause significant discomfort and threaten the health of the cornea. Understanding the common causes—ranging from age‑related tissue laxity to congenital defects—helps patients recognize early signs. Prompt evaluation by an eye specialist, appropriate lubricating therapy, and, when necessary, surgical correction can preserve vision and improve quality of life.

References

• Mayo Clinic. “Entropion.” https://www.mayoclinic.org
• American Academy of Ophthalmology. “Entropion.” AAO Preferred Practice Pattern, 2022.
• Cleveland Clinic. “Eyelid Disorders: Entropion & Ectropion.” https://my.clevelandclinic.org
• National Eye Institute (NEI). “Blepharitis and Related Conditions.” NIH, 2021.
• World Health Organization. “Eye Health.” WHO Fact Sheets, 2023.

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