Definition

Entropion is a condition where the eyelid folds inward, causing the structures and glands within the eyelid to press against the surface of the eyeball. This misalignment is a form of eyelid abnormality and is more common in older adults. The incidence of entropion increases with age: it affects approximately 0.9% of individuals aged 60-69 years, 2.1% of those aged 70-79 years, and 7.6% of those over 80 years old. Entropion often occurs in both eyes rather than just one.

Causes

Entropion can result from several factors. The first cause is loss of strength in the eyelid support muscles, causing the eyelid to turn inward. This is the most common cause of entropion in the elderly. Moreover, scars on the eyelid skin, resulting from chemical trauma, burns, surgery, or other trauma, can lead to stiffness and inward turning of the eyelid.

Entropion can also be caused by trachoma infection, caused by bacteria called Chlamydia trachomatis. This infection is common in developing regions of Asia, Africa, the Middle East, and the Pacific Islands. It can cause scarring on the inner eyelid, leading to entropion and potential blindness. Non-infectious inflammation, such as from dry eyes, can irritate the eyes, leading to rubbing or tightly closing the eyes, which can cause acute stiffness in the eyelid muscles and result in inward turning of the eyelid.

Other rare causes that can occur is congenital disorders. Entropion can be congenital, often due to excess skin folds that cause the eyelids to fold inward.

Risk Factor

Risk factors for entropion are age, history of trauma, and infection. The older the age, the higher the risk of someone experiencing entropion. The risk increases as the muscles and tissue structure of the eyelids weaken with aging. In addition, a history of trauma can be a risk factor, particularly trauma that leaves scars, such as burns. Imperfect healing can replace healthy skin with scar tissue, leading to stiffer eyelids. especially trauma that leaves scars, such as burns. Healing of the scars does not occur perfectly, so that healthy skin is replaced by scar tissue that makes the eyelids stiffer. Trachoma infection is also associated with entropion.

Symptoms

People with entropion usually experience a foreign body sensation in the eye, as well as eye redness and watery eyes. Not only that, other symptoms that can occur are increased sensitivity to bright light and wind. In addition to these symptoms, patients can experience entropion along with dry eye syndrome.

Diagnosis

To diagnose entropion, the doctor will first ask about your medical history, including any history of eye trauma, injury, or infection that could have damaged the eyelids. A visual examination, such as examining visual acuity, will help determine if there is any visual impairment. The doctor will also examine the eyes for signs of muscle stiffness, infection, irritation, and scars.

The doctor may also turn your eyelids to check for scars or scar tissue, and also pull and release your eyelids to check their flexibility. Normally, eyelids should return to their original position without blinking. However, if your eyelids are less flexible, you may need to blink to return them to normal. If the eyelid retraction itself is difficult, it is possible that the entropion is caused by scar tissue from trauma or previous surgery.

Other than examining the eyelids, the doctor will observe the position and direction of the eyelashes. In patients with entropion, the eyelashes can point inward, which is called trichiasis. This condition can cause scratches on the cornea (the clear layer above the iris of the eye) which can then cause impaired vision. In addition to these examinations, the doctor can use dye to look for scratches or wounds on the cornea as a complication of entropion.

Management

The management of entropion varies depending on the underlying cause. In entropion due to muscle weakness, there are non-surgical or surgical treatment options. Non-surgical options are typically pursued if surgery is delayed or the patient cannot undergo surgery. Non-surgical therapies include botulinum toxin (botox) injections to help temporarily pull the eyelid outward.  Pressing the eyelid towards the cheekbone to encourage the eyelid to turn outward can also help. Surgical intervention can be performed to reposition the eyelid using stitches. However, this approach offers only temporary relief, and follow-up visits may be necessary for repeat treatments.

Meanwhile, in entropion due to muscle stiffness, botox injections are also effective as treatment options for this type of entropion due to their muscle-relaxing properties.

In entropion due to scar tissue, the treatments will depend on the underlying cause. If the entropion results from conditions like Stevens-Johnson Syndrome (SJS), pemphigoid, or trachoma, the doctor will prescribe appropriate medications to treat these conditions. Surgical options include eyelid repositioning, involving suturing the eyelid or using a graft (tissue taken from another part of the body, such as the mouth) to correct the inward folding.

Complications

Entropion can lead to several complications, particularly injuring the cornea. Corneal injury can cause severe pain and vision impairment. In extreme cases, the injury can lead to infection and potential blindness.

There are also complications occurring after the surgical procedures. Bleeding, infection and graft can occur quickly after the surgery. Bleeding is usually controlled by cauterizing the bleeding site. Infections are usually prevented with antibiotic prescriptions. Complications surrounding graft failure can also be prevented by proper positioning of the graft.

Entropion surgery does not always offer a permanent solution. The most common post-surgical complication is the recurrence of entropion. Additionally, if the eyelid retraction during surgery is too aggressive, it may result in ectropion—the outward folding of the eyelid, which is the opposite of entropion.

Prevention

Preventing entropion can be challenging, especially when it is caused by age-related muscle weakness. However, some causes, such as trachoma, can be prevented by maintaining good eye hygiene and avoiding sharing towels or eye products.

When to See a Doctor?

Seek medical attention if you experience any of the following symptoms:

• Eye redness
• Eye pain
• Sensitivity to light
• Decreased vision

These symptoms could indicate a corneal problem, a potential complication of entropion. You should also see a doctor if you notice a persistent sensation of foreign body in the eye or if your eyelashes are growing inward. Left untreated, entropion can lead to corneal damage, vision impairment, and even blindness.

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