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Entropion

Definition


Disease: Entropion Entropion
Category: Eye diseases

Disease Definition:

When the eyelid turns inward, entropion occurs, which is when the eyelashes and skin rub against the eye surface and cause irritation and discomfort. In case someone has entropion, their eyelid could be turned inward all the time or it could turn inward only when they blink forcibly or squeeze their eyelids shut tightly. Usually, entropion occurs in older adults, and affects women more than men. This condition usually affects the lower lid alone.

 

The person will most probably need surgery to correct entropion; however, they could use artificial tears and lubricating ointments in order to relieve their symptoms. This disease could damage the cornea, the clear part of the eye, leading to vision loss.
 

Work Group:


Symptoms, Causes

Symptoms:

The friction of the eyelashes and outer eyelids against the surface of the eye could cause these signs and symptoms of entropion:

 

  • Decreased vision
  • Eye irritation or pain
  • Watery eyes or excessive tearing
  • Sensitivity to light and wind
  • Redness of the white part of the eye
  • Mucous discharge and eyelid crusting
  • The feeling that there’s something in the eye.

 

Someone should see a doctor for an evaluation in case they constantly feel that there’s something in their eye, or if they notice that some of their eyelashes seem to be turning in toward their eye. They should be sure to use artificial tears and eye-moisturizing ointments in order to protect their eye, because if they leave entropion untreated for too long, it could cause permanent damage to the eye.

 

A person should also watch for signs and symptoms of cornea exposure or ulcers, such as pain, light sensitivity, decreasing vision or rapidly increasing redness in case they know that they have entropion. They should seek immediate medical care in case they experience any of these vision-threatening signs and symptoms.
 

Causes:

Some of the things that could cause entropion are:

 

Skin diseases or infections:

Ocular herpes or other skin diseases or infections could result in entropion.
Trachoma, which is an eye infection, is quite common in North Africa and South Asia and could cause scarring of the inner eyelid and lead to entropion, in some cases, even blindness.

 

Muscle weakness:

The muscles under the eyes tend to get weaker as a person ages and the tendons stretch out. Entropion could develop if they get too weak and relaxed.

 

Scars or previous surgeries:

Entropion could be caused when the normal curve of the eyelid gets distorted due to scarred tissue from trauma, chemical burns, radiation or surgery.

 

Abnormal fetal development:

In some rare cases, entropion could be congenital. Usually, a baby with congenital entropion has epiblepharon, which is an extra fold of skin on the eyelid.

 

Drug reactions:

In some rare cases, a severe enough inflammation of the conjunctiva and skin of the eyelid due to adverse reactions to oral or topical drugs, including some of the medications used to treat glaucoma, could cause the tissues to scar and shrink, leading to entropion.

 

Eye surgery:

In some cases, after surgery, an eyelid problem called a spastic entropion may affect people temporarily, lasting only until the eye is completely healed. Infection, trauma or inflammation could also cause spastic entropion.
 

Complications

Complications:

Corneal irritation and damage is the most serious complication that is associated with entropion. The cornea is more susceptible to corneal breakdown and ulcers, which can cause permanent loss of vision because the eyelashes and eyelids are constantly rubbing the cornea. In order to protect the cornea and prevent damage, a person should use lubricating eyedrops and ointments until they have surgery to correct entropion.
 

Treatments:

Someone with this condition is most likely to need surgery to correct entropion, despite the fact that treatments are available to relieve symptoms and protect the eye from damage. In case this condition is caused by active inflammation or infection, as the inflamed or infected eye is treated, the eyelid may return to its normal alignment. But sometimes, entropion persists even after the other condition has cleared up.

 

Skin tape:

In order to keep the eyelid from turning in, special transparent skin tape could be applied to that eyelid. One end of the tape should be kept in place near the lower eyelashes, and then the other end of the tape should be gently pulled down and attached to the upper cheek. The doctor could show the patient the proper technique and placement of the tape.

 

Stitches that turn the eyelid outward:

This procedure could be performed with local anesthesia in the doctor’s office. After numbing the eye, two or three stitches are placed in specific locations along the eyelid. These stitches turn the eyelid outward, and the resulting scar tissue keeps it in position even after the stitches are removed. However, there’s a high likelihood that the eyelid will turn itself back inward within several months of the stitching, making this method a short-term solution.

 

Botulinum toxin:

The eyelid could turn out when small amounts of botulinum toxin is injected in the lower eyelid. The effects will last three to six months, and the person will get a series of injections. In case someone has temporary spastic entropion immediately after another eye surgery, this method could help them because before the effects of botulinum toxin wear off, the entropion will have resolved itself.

 

SURGERY:

In most cases of entropion, surgery is required; depending on the cause and condition of the surrounding tissue, several surgical techniques are available for entropion. The patient will receive a local anesthetic to numb their eye area before the surgery and in order to make them more comfortable, they will be lightly sedated using oral or intravenous medications.

 

In case muscle and ligament relaxation due to aging is causing entropion, then a small part of the lower eyelid will be removed, which will end up tightening the tendons and muscles of the lid. The patient will have a few stitches just below their lower eyelid or on the outside corner of their eye.

 

A skin graft taken from the upper eyelid or behind the ear may be needed to correct the entropion, in case the patient has scar tissue or previous surgeries.

 

Wearing an eye patch may be required for the next 24 hours following the surgery and then the use of an antibiotic and steroid ointment on the eye several times a day for one week. In order to decrease bruising and swelling, a person could use cold compresses periodically, and in order to decrease the pain, they could use acetaminophen. Because acetylsalicylic acid tends to increase bleeding, it should be avoided.

 

The eyelid might feel uncomfortable at first, however, as it heals, the soreness and irritation will diminish. In some cases, symptoms are relieved almost immediately after surgery. A week after the surgery, the stitches will be removed, however, the patient should be careful not to pull on the eyelid to apply eyedrops for at least a month after the surgery.
 

Prognosis:

Not available

Expert's opinion

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