Eyelid Turned In (Entropion)

Written by Janet Barwell and Marijane Leonard | Published on July 18, 2012
Medically Reviewed by George Krucik, MD

Overview

Entropion refers to a condition in which your eyelid rotates inward. Your eyelashes rub against your eye and cause redness, irritation, and abrasions on the cornea of your eye.

Entropion, or eyelid retraction, develops slowly and may not be noticeable in its early stages. Over time, however, the condition worsens until every movement of the eye irritates the surface of the cornea. Without treatment, this continuous abrasion can cause eye infections and scarring of the eyeball. With a serious case, you can lose sight in the affected eye.

Entropion is a common condition among the elderly. The lower eyelid is most often affected, and it can occur in one or both eyes. Treatment involves a relatively simple surgery that can be performed in the doctor’s office.

What Causes Entropion?

Entropion has a number of causes. All of them involve loosening of the muscles that control the eyelids.

Senile Entropion

As you grow older, your skin loses collagen, and your eyelid muscles grow slack. Loose muscles and skin around the eyes can allow the edge of the eyelid to flip inward.

Congenital Entropion

Babies may be born with entropion; however, the condition is quite rare.

Chemical Burns or Surgeries

Chemical burns and surgeries can change the shape of the eyeball and allow the eyelid to become loose and turn inward.

Trachoma

Turned-in eyelids are one of the telltale symptoms of trachoma, a common eye disease found in regions of Africa, Asia, and the Middle East. The disease is caused by bacteria and is one of the most common sources of blindness in developing countries. It is spread from person to person through shared washcloths or towels. Flies can also transmit the infection between people. If you develop eye problems and have recently traveled to an area where trachoma is present, you should discuss your travels and eye problems with your doctor.

Herpes Zoster Ophthalmicus (HZO)

HZO is a herpes infection of the eye that can result in many problems including entropion. The virus, related to chickenpox and shingles, can lie dormant in the body for decades and become active as shingles later in life. HZO is a severe and painful condition that requires intensive treatment.

What are the Symptoms of Entropion?

Entropion symptoms often develop slowly, starting out as just a mild eye irritation. As the eyelid rolls inward, the eyelashes start to scratch your cornea. Over time, repeated abrasion to you cornea can lead to:

  • eye redness
  • watery, teary eyes
  • infections of the cornea
  • scarring
  • loss of vision

How Is Entropion Diagnosed?

Entropion is generally easy to diagnose visually. Your doctor will ask about any possible causes, such as previous eye injuries, diseases, or chemical exposure. Your doctor may perform a snap test. This involves gently pinching the eyelid and lifting it up to see how fast it snaps back into place. If you are losing collagen and muscle tone, this test helps confirm the visual diagnosis.

How Is Entropion Treated?

You can often achieve short-term relief by gently pulling and taping the eyelid to the outside of the eye. This creates tension that causes the eyelid to flip away from the surface of the eye. Botox injections may be used to achieve the same result.

In most cases, surgery will be required to tighten the muscles around the eyelids. Surgery can be performed in your doctor’s office using a local anesthetic. The surgery involves placing stitches in the eyelid to tighten it and turn it back outward.

After surgery, your doctor may prescribe eye drops and use of an eye patch overnight to protect the eye. You should notice improvement within a day or so. Repeated surgeries may be required in about 15 percent of cases as the patient ages and the eyelid tissue continues to loosen.

Can Entropion Be Prevented?

Entropion that develops from aging is generally not preventable. But you can reduce your risk by using eye protection when working around chemicals or other eye hazards.

If you are planning to travel to parts of Africa or Southeast Asia where trachoma is common, talk to your doctor about how to protect yourself from tropical diseases.

What Is the Outlook for People with Entropion?

With proper treatment, you should make a full recovery from entropion. Repeat surgeries may be necessary over time to further tighten the eyelid muscles.

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