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Entropion

Overview

Entropion is a problem with the eyelid. Usually, the lower eyelid turns inward, causing the eyelashes and skin of the eyelid to rub against the surface of the eye. This rubbing creates irritation and discomfort.

Imagine your eyelid is like a little door. In entropion, that door is slightly crooked, and it's pointing inward. This means the eyelashes and the skin of the eyelid are pressing against your eye. This can happen all the time, or just when you blink strongly or close your eyes tightly.

Entropion is more common in older people, and it often only affects the lower eyelid.

Simple solutions like artificial tears or lubricating ointments can help ease the discomfort. These help to keep the eye moist and reduce the rubbing. However, surgery is usually needed to fix the inward turning of the eyelid permanently.

If entropion isn't treated, it can lead to serious problems. The rubbing can damage the clear front part of your eye (the cornea). It can also cause infections and, in severe cases, vision loss. Early treatment is important to prevent these complications.

Symptoms

Entropion happens when your eyelashes and eyelid rub against your eye. This rubbing causes several uncomfortable symptoms. You might feel like something is stuck in your eye, experience redness, irritation, or pain. Bright light and wind can also bother you. Your eyes might water excessively, and you might notice mucus or crusting around your eyelids.

If you've been diagnosed with entropion and notice any of these changes, seek medical attention right away:

  • Your eyes get much redder quickly.
  • You feel a lot of pain.
  • Your eyes are extra sensitive to light.
  • Your vision gets worse.

These are signs that the surface of your eye (cornea) might be getting hurt, which could affect your sight.

If you frequently feel like you have something in your eye, or if you notice your eyelashes turning inward, schedule a doctor's appointment. Untreated entropion can permanently damage your eye.

To protect your eye before your appointment, use artificial tears and lubricating eye ointments. These will help soothe the rubbing and irritation.

When to see a doctor

If you've been diagnosed with entropion, get medical help right away if you notice:

  • Your eyes getting redder quickly.
  • Eye pain.
  • Your eyes being very sensitive to light.
  • Your vision getting worse.

These are signs that your eye's surface (cornea) might be injured. A cornea injury can permanently harm your vision.

Schedule a doctor's appointment if:

  • You feel like something is constantly in your eye.
  • You notice your eyelashes are growing inward towards your eye.

Entropion left untreated can lead to lasting eye problems. To protect your eye before your appointment, start using artificial tears or lubricating eye drops. These will help keep your eye moist.

Causes

Entropion happens when the edge of your eyelid rolls inward, causing your eyelashes to rub against your eye. This can be painful and lead to problems like infections. Several things can cause this:

  • Aging: As we get older, the muscles and tissues around our eyes can weaken and stretch. This is the most common reason for entropion in adults. Think of it like a loose hinge on a door; it can make the eyelid bend inward more easily.

  • Scars: If you have scars on your eyelids from things like burns, injuries, or past eye surgeries, these scars can change the shape of your eyelid and pull it inward. Imagine a scar pulling on a piece of fabric; it can alter its shape.

  • Infections: A serious eye infection called trachoma is a significant cause of entropion in certain parts of the world, especially developing countries in Africa, Asia, Latin America, the Middle East, and Pacific Islands. Trachoma can cause the inner eyelid to become scarred, making it more likely to roll inward. This scarring can even lead to blindness if not treated.

  • Irritation and rubbing: If your eyes are dry or irritated, you might rub or squeeze them to relieve the discomfort. This can sometimes cause the eyelid muscles to spasm, pulling the eyelid edge inward against your eye. This is called spastic entropion.

  • Birth defects: Sometimes, entropion is present from birth (congenital). This might be due to extra skin or tissue on the eyelid that causes the eyelashes to turn inward.

Understanding the cause of entropion is important for getting proper treatment. If you think you might have entropion, it's crucial to see an eye doctor for a diagnosis and the best course of action.

Risk factors

Entropion is a condition where your eyelids turn inward. Several things can raise your chances of getting it.

  • Getting older: The older you get, the more likely you are to develop entropion. This is because the skin and tissues around your eyes naturally change over time, making them more prone to this problem.

  • Past injuries: If you've had a burn or other injury to your face, the resulting scar tissue can sometimes pull on your eyelids, increasing your risk of entropion. This is because the scar tissue can cause the eyelid to become tighter and more likely to turn inward.

  • Trachoma: Trachoma is an eye infection that can cause scarring on the inside of the eyelids. This scarring can make the eyelids more prone to turning inward, increasing your risk of entropion. Trachoma is a serious infection, and if you have a history of it, it's important to discuss your risk with an eye doctor.

Complications

Entropion, a condition where the eyelid turns inward, can cause serious eye problems. One of the most concerning complications is irritation and injury to the cornea, the clear front part of the eye. This irritation and injury can potentially result in permanent vision loss. In other words, if the eyelid turns inward and rubs against the cornea, it can severely damage the eye and lead to permanent vision problems.

Prevention

Entropion is usually something you can't stop from happening. However, there's a type of entropion that might be preventable. This is the kind connected to a bacterial infection called trachoma. If you've been in a place where trachoma is common and your eyes get red and sore, it's very important to see a doctor right away for diagnosis and treatment. Early treatment can often help prevent the condition from developing.

Diagnosis

Entropion is often found during a regular eye exam. During the exam, your eye doctor might gently pull on your eyelids or ask you to blink or close your eyes a few times. This helps them see how your eyelids are positioned on your eye, how strong the muscles in your eyelids are, and how tight they feel.

If your entropion is linked to scar tissue, past eye surgeries, or other medical issues, your doctor will also examine the surrounding areas of your eye. They'll look at the tissue around your eyelids to understand the cause of the entropion.

Treatment

Entropion Treatment Options: Understanding the Different Approaches

Entropion is a condition where the eyelid turns inward, rubbing against the eye. The treatment plan depends on what's causing the inward turning. There are both surgical and non-surgical approaches.

Non-Surgical Options:

These options aim to ease symptoms and prevent eye damage until a more permanent solution is possible. If the entropion is caused by inflammation or infection (spastic entropion), treating the underlying issue often helps the eyelid return to its normal position. However, if scarring has occurred, the inward turning may persist even after the initial problem is resolved.

  • Soft Contact Lenses: A soft contact lens can be used like a bandage to help protect the eye and ease discomfort. These lenses can be prescribed with or without correcting vision issues.

  • Botox Injections: Small amounts of Botox can be injected into the lower eyelid to help pull the eyelid outward. These injections may need to be repeated, and the effects usually last up to six months.

  • Stitches to Correct the Eyelid: In this procedure, stitches are placed along the inside of the eyelid to gently pull it outward. The body creates scar tissue to hold the eyelid in place, but this is not a permanent solution. The eyelid might return to its inward position after a few months. This procedure is usually performed in a doctor's office using local anesthesia.

  • Skin Tape: Temporary relief can be achieved by applying special, clear tape to the eyelid to hold it in place.

Surgical Options:

Surgery is often necessary for a long-term solution to entropion. The specific surgery will depend on the underlying cause and the condition of the eyelid tissue.

  • Age-Related Entropion: If the inward turning is due to age-related changes, the surgeon might remove a small section of the lower eyelid. This helps to tighten the muscles and tendons, and a few stitches may be placed on the outer edge or just below the lower eyelid.

  • Entropion Caused by Scar Tissue or Previous Surgeries: If scar tissue is present, or if the entropion is due to previous trauma or surgeries, the surgeon might use a mucous membrane graft. This involves taking tissue from the roof of the mouth or nasal passages and using it to cover the affected area.

Before Surgery:

Before any surgery, a local anesthetic will numb the eyelid and surrounding area. Light sedation might also be used to help you feel more comfortable during the procedure, depending on the type of surgery and location.

After Surgery:

  • Post-operative Care: You will likely need to apply an antibiotic ointment to your eye for one week following surgery.

  • Potential Side Effects: You might experience temporary swelling and bruising around the eye. The eyelid may feel tight initially, but this will improve as you heal.

  • Stitches Removal: Stitches are typically removed about a week after surgery.

  • Healing Time: Swelling and bruising should subside within about two weeks.

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