What is entropion?
Entropion is a condition in which the eyelid folds inward, causing the eyelashes to brush against the surface of the eye with every blink. Unlike ectropion – where the eyelid turns outward – entropion directs the lash line toward the cornea, creating constant friction that the eye was not designated to tolerate.
The lower eyelid is most commonly affected. What begins as mild eyelash irritation to the eye can progress to corneal damage, scarring, and vision problems if left untreated.
Types of entropion
Entropion is classified as either congenital (present from birth) or acquired (develops over time). Congenital entropion is rare. There are four acquired types:
Involutional – The most common type. Age-related weakening of the eyelid muscles and tendons allows the lid to rotate inward over time.
- Cicatricial – Scarring of the inner eyelid surface – from infection, inflammation, or injury – causes the tissue to contract and pull the lid inward.
- Spastic – Prolonged eye irritation or inflammation triggers muscle spasms that force the lid inward. This type is sometimes temporary.
- Mechanical – A mass or structural abnormality near the eyelid disrupts its normal positioning, causing it to turn inward.
What are the symptoms of entropion?
The most common symptom of entropion is the sensation of eyelashes constantly contacting the eye. Symptoms can range from mildly irritating to severely disruptive and tend to worsen over time without treatment:
- Persistent feeling that something is in the eye
- Eye redness and inflammation
- Watery or teary eyes
- Light and wind sensitivity
- Mucous discharge or eyelid crusting
- Eye pain with blinking
- Blurred or fluctuating vision
- Intolerance to contact lenses
As entropion progresses, the repeated friction of lashes against the cornea can cause abrasions, ulcers, or permanent scarring – all of which carry risk to vision.
What causes entropion?
The eyelid relies on a precise balance of muscle tone, tendon strength, and tissue integrity to maintain its position. When any of these are compromised, the lid can begin to turn inward.
Common causes include:
- Age-related tissue changes – Decades of blinking gradually stretch and weaken the tendons and muscles that anchor the eyelid. This is the most common reason entropion develops.
- Conjunctival scarring – Inflammatory conditions, infections, or chemical injuries can scar the inner lining of the eyelid. As this scar tissue tightens, it pulls the lid margin toward the eye.
- Eyelid muscle spasms – Chronic irritation, dry eye, or post-surgical inflammation can cause the muscles surrounding the eye to contract involuntarily, temporarily rotating the lid inward.
- Trauma or prior surgery – Physical injury or changes to the eyelid anatomy from previous procedures can alter the structural relationships that keep the lid properly positioned.
- Congenital factors – Rarely, infants are born with entropion due to an extra skin fold or underdeveloped lid structures.
How is entropion diagnosed?
Entropion is typically diagnosed through a physical examination of the eyelid. This includes observing the resting position of the lid, test its tension and laxity by gently manipulating the tissue, and assessing how the lid behaves under muscle contraction.
The surface of the eye will also be examined for corneal damage. If scarring or an underlying inflammatory condition is suspected, further testing may be ordered to identify the cause before treatment is planned.
How is entropion treated?
Treatment is guided by the type and cause of entropion, as well as the degree of corneal involvement. Addressing the condition promptly reduces the risk of lasting damage to the eye.
When surgery needs to be delayed or symptoms are mild, temporary measures can help manage discomfort and protect the cornea:
- Lubricating drops and ointments to reduce surface friction
- A bandage contact lens to shield the cornea from lash contact
- Botulinum toxin injections to relax spasming eyelid muscles in spastic entropion
- Adhesive tape applied externally to hold the lid in a more natural position
These options manage symptoms but do not correct the underlying problem. Surgery is the definitive solution for most patients and produces lasting results. Eyelid surgery repair is performed on an outpatient basis under local anesthesia.
The technique used depends on the type of entropion:
- Involuntarily entropion is corrected by tightening and repositioning the lower eyelid’s supporting structures to prevent inward rotation.
- Cicatricial entropion requires releasing contracted scar tissue along the inner lid. A mucous membrane graft may be used to restore the inner eyelid surface where scarring has caused significant tissue loss.
- Congenital entropion is evaluated on a case-by-case basis, with surgical intervention timed based on severity and the risk to the child’s developing vision.
Swelling and bruising after surgery are expected and typically resolve within one to two weeks. The majority of patients experience complete resolution of symptoms once the eyelid heals in its corrected position.
When your eyelid turns inward, even routine moments can become genuinely uncomfortable. Our oculofacial plastic surgeons can assess what’s happening with your eyelid and recommend the most appropriate course of treatment. Call 515.875.9480 to schedule an appointment today.