Defined by a malposition of the upper or lower eyelid, entropion usually affects the elderly. This malposition is a source of visual discomfort and eye infections. The treatment is surgical. Explanations.

Entropion is a coiling of the upper or lower eyelid inwardly of the eye, leading to rubbing of the eyelashes against the eyeball, causing tearing, irritation of the cornea, conjunctiva and often d eye infection.

It most commonly affects older people due to age-related sagging of the eyelid tissue and muscles around the eyes. But it can also, more rarely, concern younger subjects and be the scarring consequence of a chemical or thermal burn, or of a wound of the eyelid. Finally, there are also entropions linked to an eyelid spasm, following chronic irritation of the eyeball and repeated blinking.

With entropion, the eyelashes are hardly visible and the eyelid takes on a swollen and pudgy appearance. There is a real vicious circle between entropion, the chronic irritation that feeds the spasm of the eyelid and its coiling. It causes a feeling of discomfort and a foreign body in the eye due to the rubbing of the eyelashes against the wall of the eye. It is most often accompanied by:

• Redness;
• Irritation of the eyeball;
• Superinfection (superinfected conjunctivitis). 

It is also at the origin of a more abundant chronic lacrimation, disturbing the vision. These symptoms can be maintained and aggravated by rubbing reflexes with the hands or a tissue to remove excess tear secretions and calm the feeling of irritation.

The diagnosis is clinical by observing a malposition of one or more eyelids of the eyes in the direction of the rolling of the eyelid inward. Typically, the patient presents with a red, watery, or photophobic (light sensitive) eye.

During a macroscopic examination, the doctor studies the face as a whole. Any facial spasm, signs of irritation or skin infection should be noted. Particular attention is paid to the structures of the edges of the eyelid in order to assess the presence of scar tissue or trichiasis cilia in the event of entropion. He may ask to blink or to forcefully close his eyes. This helps to assess the position of the eyelid on the eye and its muscle tone. 

Digital traction tests assess the horizontal and vertical laxity of the eyelids. The doctor pulls the lower eyelid down and observes its spontaneous return to the initial position. Spastic entropion can be caused by forcefully closing the eyelids. If this persists with eye movements and blinking, a diagnosis of spastic or intermittent entropion can be made. The slit lamp examination with fluorescein reveals possible corneal complications such as superficial punctate keratitis or ulceration. Careful examination of the conjunctiva is important.

First aid for entropion

The first aid to be given is the prescription of antiseptic eye drops and lubricating ointments. Wearing a protective lens may also be suggested to protect the cornea against irritation of the eyelashes. Advice may also be given to rub the eyes as infrequently as possible, with clean hands or a disposable tissue. 

In case of spasmodic entropion

For spasmodic entropion, it is possible to inject small amounts of botulinum toxin into the muscles of the eyelid. But the definitive treatment of entropion remains the surgical intervention which takes place in the operating room under local anesthesia with the aim of repositioning the eyelid to unroll it and allow it to close normally. In some cases, a skin graft is needed on the upper eyelid. The patient, after agreement of the surgeon can leave a few hours after the operation.

What are the operative consequences of entropion?

Immediately after the operation, an edema and a hematoma are present in the eye region which has been operated on, which will subside in about ten days. Eye drops and eye ointments will be prescribed for one month. A first postoperative appointment will be made to assess the progress of healing and to remove the stitches. A final appointment is given one, two or three months after the operation to assess the final result. Complications from this delicate surgery are rare.