Turned-In Eyelid (Entropion)

Entropion is a condition where the upper or lower eyelid turns inward, rubbing the lashes against the eye, causing the eye to become irritated, red, and sensitive to light and wind. If it is not treated, the condition can lead to pain, tearing, discharge, and irritation. If entropion is severe or left untreated for a long period of time, it can lead to corneal damage and decreased vision. Entropion can be diagnosed with a routine eye exam. Special tests are usually not necessary.

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Entropion can be caused by muscle weakness. As we age the muscles around the eyes tend to weaken. Laxity of the eyelid tendons, combined with weakening of these muscles result in the eyelid turning in. Some patients have eyelid spasms, forceful blinking, squeezing, or other neurological conditions that cause the eyelid to roll inward. Entropion may also occur as a result of trauma, scarring, or previous surgery.

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When the lid turns inward, the lashes and the skin rub on the eye. There may be a foreign body sensation in the eye, or excessive tearing, crusting of the eyelid, or discharge. Irritation of the cornea may develop from lashes rubbing on the eye. A chronically turned-in eyelid can result in acute sensitivity to light and wind, and may lead to eye infections, corneal abrasions, or corneal ulcers. If entropion exists, it is important to have a doctor repair the condition before permanent damage occurs to the eye.

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Treatments
Entropion usually requires surgical treatment. Prior to the surgery, the eye is protected by applying tape to the lower eyelid and using lubricating ointment. There are a number of surgical techniques for successful treatment and each surgeon will have a preferred method. The usual treatment for entropion involves tightening any laxity of the eyelid and its attachments to restore the lid to its normal position.

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An excellent treatment for patients who are not able to have surgery is the Quickert procedure. This procedure requires two or three strategically placed sutures that will turn the eyelid in temporarily.

The definitive surgery to repair entropion is most commonly performed as an outpatient procedure under local anesthesia with or without sedation. Antibiotic ointment may be prescribed for about a week following the surgery.

Most patients experience immediate resolution of the problem once surgery is completed with little, if any, postoperative discomfort.

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Patients with entropion from forceful eyelid blinking, spasms, or squeezing may benefit from a non-surgical treatment option. Botulinum toxin injections into the overactive eyelid squeezing muscles can weaken them for several months, allowing the eyelid to roll back into its natural position. This may also be a good option for patients who cannot have surgery.

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Risks and Complications
Bleeding and infection, which are potential risks with any surgical procedure, are very uncommon. As with any medical procedure there may be other inherent risks including but not limited to anesthesia risks, swelling, scarring, or further surgery needed. Minor bruising or swelling may be expected and will likely go away in one to two weeks. Be sure to tell your surgeon if you are on blood thinners as their use may put you at increased risk for bleeding complications.

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Your surgeon cannot control all the variables that may impact your final result. The goal is always to improve a patient’s condition but no guarantees or promises can be made for a successful outcome in any surgical procedure. There is always a chance you will not be satisfied with your results and/or that you will need additional treatment. As with any medical decision, there may be other inherent risks or alternatives that should be discussed with your surgeon.