Entropion: Symptoms, Types, Causes and Treatment

Entropion is a condition where the eyelid turns inward, causing the eyelashes and skin to rub against the eye surface. This may sound like a minor inconvenience, but if left untreated, entropion can lead to significant discomfort and even vision loss. In this comprehensive article, we’ll break down the symptoms, types, causes, and treatments of entropion, drawing on current research and clinical experience to help you understand this common yet often overlooked eye disorder.

Symptoms of Entropion

When the eyelid turns inward, the eye is immediately exposed to a range of irritations. Many people notice the symptoms first before they realize something is wrong with their eyelid position. Recognizing these signs early can prevent complications and ensure better outcomes.

Symptom	Description	Consequence	Source(s)
Discomfort	Irritation, foreign body sensation	Constant eye rubbing	1 2
Redness	Inflammation of conjunctiva/cornea	Persistent eye redness	1 2 5
Tearing	Excessive lacrimation	Watery eye, blurred vision	1 2
Corneal Damage	Abrasion, ulceration, scarring	Vision loss risk	1 2 5

Table 1: Key Symptoms

Understanding the Symptoms

Many patients with entropion experience a persistent sensation that there’s something in their eye. This discomfort is often accompanied by redness as the eyelid margin and lashes rub against the sensitive surface of the cornea and conjunctiva 1 2. Tearing is common; the body tries to flush out the irritant but cannot resolve the root cause. If left unchecked, the friction can cause corneal abrasions or ulcers, sometimes leading to permanent scarring or even vision loss 1 2 5.

Why Symptoms Should Not Be Ignored

• Corneal Complications: Continuous irritation puts the cornea at risk for infection, thinning, and neovascularization (growth of new blood vessels), which can threaten sight 1 2.
• Chronic Discomfort: People often rub their eyes to alleviate the sensation, which can make things worse.
• Visual Disturbance: Over time, corneal scarring or ulceration can blur vision or cause painful episodes.

When to Seek Help

If you notice any of these symptoms—especially if they persist or worsen—prompt evaluation by an eye care professional is essential. Early intervention can prevent long-term damage.

Types of Entropion

Entropion is not a one-size-fits-all diagnosis. Understanding the different types helps guide the right treatment and anticipate possible outcomes. Each variety has unique features and underlying mechanisms.

Type	Main Features	Common Age/Group	Source(s)
Involutional	Age-related, lower lid common	Elderly	1 2 3 6
Cicatricial	Scarring causes inward turning	Any (often adults)	1 2 12
Spastic	Muscle spasm, usually transient	All ages	1 5
Congenital	Present at birth	Infants/children	1 2 9 12
Mechanical	External pressure, e.g., obesity	All ages (rare)	7 5

Table 2: Types of Entropion

Involutional Entropion

This is the most common form, especially in older adults. Over time, the tissues supporting the lower eyelid weaken, causing the lid to turn inward. It’s more prevalent as people age, likely due to age-related changes in the eyelid’s structure and supporting muscles 1 2 3 6.

Cicatricial Entropion

Here, scarring (from injury, inflammation, or disease) on the inner surface of the eyelid pulls the margin inward. It can affect both upper and lower lids, depending on the cause 1 2 12.

Spastic Entropion

This type is usually caused by muscle spasms in response to irritation or trauma. It tends to be temporary, resolving once the underlying irritation is treated 1 5.

Congenital Entropion

A rare form seen in infants and young children, congenital entropion is present from birth. It’s often due to abnormal development of eyelid structures 1 2 9 12. Quick recognition and treatment can prevent corneal injury in these vulnerable patients.

Mechanical Entropion

Sometimes, external factors like tumors, swelling, or in rare cases, obesity, can physically push the eyelid inward. Treating the underlying cause is key in these situations 7 5.

Causes of Entropion

Understanding what drives entropion is essential for both prevention and treatment. The causes are multifactorial, often involving a combination of anatomical, mechanical, and sometimes genetic factors.

Cause	Mechanism/Factor	Primarily Affects	Source(s)
Age-related Laxity	Weakening of eyelid tissues	Elderly (lower lid)	2 3 4 6
Scarring	Damage to inner eyelid	Any age	1 2 12
Muscle Overriding	Preseptal muscle displacement	Older adults	6
Congenital Defect	Abnormal development	Infants/children	1 2 9
External Pressure	Tumors, obesity	All ages (rare)	7 5

Table 3: Common Causes

Age-Related Changes (Involutional)

The most frequent culprit is simply the passage of time. As we age, the connective tissue and muscles supporting the lower eyelid become lax. The tarsal plate (a stiff structure within the eyelid) may also shrink or atrophy, further destabilizing the lid 2 3 4 6. Weakness of the lower eyelid retractors and laxity of the canthal ligaments also contribute 2 4 6.

Scarring (Cicatricial)

Any condition causing scarring of the inner eyelid (conjunctiva or tarsal plate) can create a pulling force that turns the lid inward. Common causes include infections, chronic inflammation, injuries, burns, or certain autoimmune diseases 1 2 12.

Muscle Dysfunction and Overriding

In some cases, the orbicularis oculi muscle (responsible for eyelid closure) overrides the supporting tarsal plate, especially when weakened by age or disease. This mechanical imbalance tips the eyelid margin inward 6.

Congenital Factors

Some children are born with entropion due to abnormal eyelid anatomy or muscle development. These cases may resolve as the child grows, but intervention is sometimes required to protect the eye 1 2 9.

Mechanical and Other Factors

Tumors, cysts, or even excessive facial tissue (seen in some breeds of cats and certain human cases) can mechanically force the eyelid into an abnormal position. Rarely, morbid obesity can be a cause, as increased bulk in the lower eyelid pushes it inward 5 7.

Treatment of Entropion

Treatment aims to relieve symptoms, protect the eye, and correct the lid position. The approach depends on the underlying cause, severity, and patient factors.

Treatment	Description	Duration/Outcome	Source(s)
Lubricants/Tapes	Temporary relief, eye protection	Short-term	1 2 8
Botulinum Toxin	Weakens muscle, temporary correction	Weeks to months	8 9
Everting Sutures	Sutures rotate eyelid outward	Short to medium term	1 12
Surgical Repair	Reconstructive procedures	Long-term, curative	1 2 4 10 11 12
Treat Underlying	Remove tumors, address obesity	Varies	7 5

Table 4: Treatment Strategies

Non-Surgical Approaches

• Lubricating Drops/Ointments: These provide immediate relief by reducing friction between the eyelid and the eye 1 2.
• Taping: Special adhesive tapes can temporarily pull the lid into a better position.
• Botulinum Toxin Injections: By relaxing the orbicularis muscle, botulinum toxin can temporarily correct entropion, especially in patients who cannot undergo surgery or in infants with congenital forms 8 9. Effects last several weeks to months.

Surgical Treatments

Surgery is the definitive treatment for most cases, especially when non-surgical measures fail. There are several surgical options, each tailored to the underlying cause and anatomical findings:

Everting Sutures (Quickert Procedure)

Temporary or semi-permanent sutures rotate the eyelid margin outward. This is a simple, minimally invasive approach suitable for patients who are poor surgical candidates or as a temporizing measure 1 12.

Eyelid Reconstruction

• Tarsal Strip Procedure: Tightens the outer corner of the eyelid, correcting horizontal laxity 1.
• Weis Procedure (Marginal Rotation): Rotates the eyelid margin outward 1.
• Lower Lid Retractor Advancement: Strengthens the lower eyelid retractors to correct inward turning 1 4 11.
• Orbicularis Muscle Tightening/Excision: Addressing muscle laxity and removing excess skin 11.

Combination Techniques

Often, a combination of procedures is used to target all contributing factors—vertical and horizontal laxity, muscle overriding, and scarring. This approach reduces recurrence rates and ensures better outcomes 6 12.

Treating Underlying Causes

In cases of mechanical entropion, such as that caused by tumors or obesity, the underlying issue must be addressed. Removing the tumor or, in rare cases, reducing eyelid bulk surgically can resolve the entropion 7 5.

Prognosis and Recurrence

Most surgical techniques are highly effective, with low rates of complications or recurrence when tailored to the individual's specific anatomical and functional issues 1 2 4 10 11 12. However, in some challenging cases, revision surgery may be necessary.

Conclusion

Entropion is more than a cosmetic concern—it’s a potentially sight-threatening condition that demands careful evaluation and individualized management. Here’s what you need to remember:

• Symptoms include discomfort, redness, tearing, and risk of corneal damage.
• Types range from involutional (age-related) to cicatricial (scarring), spastic, congenital, and mechanical.
• Causes are often multifactorial, with age-related tissue laxity, scarring, muscle imbalance, and external pressure all playing roles.
• Treatments span from temporary lubrication and taping to advanced surgical reconstruction, with excellent outcomes when managed appropriately.

Early recognition and tailored intervention are key to preserving eye health and vision for those affected by entropion. If you or someone you know is experiencing symptoms, a prompt visit to an eye care professional can make all the difference.