Entropion surgery

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Entropion is a condition where the eyelid turns inward, causing irritation and potential damage to the eye. Treatment involves either non-surgical options for temporary relief or corrective surgery to restore the eyelid’s normal position and prevent complications.

Key Information

PRICE

£3465

TIME OF PROCEDURE

45 min per eye

DOWNTIME

1-2 weeks

DISCOMFORT LEVEL

2 out of 5

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What is entropion?

Entropion is an eyelid condition in which the eyelid turns inward, causing the eyelashes to rub directly against the eye’s surface. This misalignment can lead to persistent discomfort, irritation, and redness. If untreated, the friction from the lashes can eventually damage the cornea, increasing the risk of infection and potential vision problems.
Entropion usually affects the lower eyelid and is more common among older adults due to age-related muscle weakening, though it can also result from injury, surgery, or inflammation.

What are the types of entropion?

Entropion can present in several forms, each with distinct underlying causes:

Involutional entropion

The most common type is usually caused by age-related muscle relaxation and weakness in the lower eyelid. Over time, this can cause the eyelid to fold inward, rubbing the lashes against the eye.

Acute spastic entropion

This type is often temporary, caused by muscle spasms or inflammation around the eye, which can pull the eyelid inward. Spastic entropion may occur following surgery or due to eye irritation.

Cicatricial entropion

This form occurs when scarring or contraction of the inner eyelid tissue pulls the eyelid inward. Conditions such as trauma, previous surgeries, or chronic inflammation can contribute to cicatricial entropion.

Congenital entropion

This is a rare form present at birth, often due to abnormal development of the eyelid muscles. It usually affects the lower eyelid and may require corrective surgery if it leads to discomfort or eye damage.

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What are the symptoms and signs of entropion?

Entropion can cause many uncomfortable symptoms in or around the eye. At first, the signs may be intermittent but become more constant over time:

  • Foreign body sensation
  • Mild redness of the eye
  • Irritation and/or soreness
  • Watery eyes and excessive tearing
  • Eyelid crusting
  • Mucous discharge

If you have been diagnosed with entropion and you start to experience any of the following symptoms, immediate medical care should be sought:

  • Blurred vision
  • Sensitivity to light or wind
  • Eye redness that is rapidly getting worse
  • Pain in or around the eye

If left untreated, prolonged irritation and inflammation can lead to vision disturbances.

Symptoms can intensify if entropion is not managed, potentially resulting in corneal damage or infections. Early diagnosis and appropriate treatment are essential for preventing these complications.

Tips to improve symptoms

While corrective surgery is often the definitive treatment for entropion, some at-home remedies can help manage symptoms and provide temporary relief:

Use of artificial tears and lubricating ointments

Regular use of artificial tears or lubricating ointments helps moisten the eye, reducing irritation from the inward-turned eyelashes.

Skin Tape

Special skin tape can be carefully placed to help keep the eyelid in a more natural position, stopping it from turning inward. Securing one end near the lower lashes and gently attaching the other end to the cheek, the tape holds the lid outward, reducing lash contact with the eye.

These approaches can alleviate discomfort and prevent worsening symptoms, but they are generally short-term solutions. For long-term relief, it is recommended that you consult an oculoplastic specialist for a more permanent corrective approach.

Woman's eye

How is entropion diagnosed?

Entropion is diagnosed during a comprehensive eye examination performed by an ophthalmologist. During the exam, the specialist will evaluate the position and movement of the eyelids to identify signs of inward turning and any associated irritation. The diagnosis process typically includes a series of tests, such as:

  • Visual acuity test, to check your overall vision.
  • Slit-lamp examination, to closely examine the eye’s structures, including the eyelid.
  • Corneal examination, to assess any damage caused by the rubbing of the eyelid.
  • Tear film evaluation, to check for tear production and any related dryness.

In addition to these tests, the ophthalmologist will gather information about your symptoms, medical history, and any medications you are taking. Understanding these factors helps in identifying the type and severity of the entropion and developing an effective treatment plan.

The diagnosis of entropion is usually straightforward and can be completed within 30 minutes to an hour, depending on the case’s complexity. However, additional tests may sometimes be needed to fully assess the condition and determine the best course of treatment.

Once diagnosed, it’s important to seek prompt treatment, as untreated entropion can lead to corneal damage and even vision loss. Treatment options may include conservative approaches or surgical correction, depending on the severity of the condition. Our specialists will work with you to create a personalised treatment plan to restore eyelid function and protect your vision.

What is the common cause of entropion?

Entropion is often associated with age-related changes in the eyelid’s structure, primarily due to the gradual weakening of muscles and tissues. As we age, the eyelid muscles and tendons supporting the lower lid can lose elasticity and strength, causing the eyelid to turn inward. This inward turn brings the eyelashes into direct contact with the eye’s surface, leading to discomfort, irritation, and potential corneal damage if left untreated.

In addition to age-related causes, other factors can lead to entropion:

  • Excessive squeezing – Irritated eyes may cause rubbing, squeezing, and blinking, which can lead to entropion due to eyelid laxity or muscle spasms. This type of entropion is known as spastic entropion.
  • Eye infections – Eye infections, such as trachoma, can cause scarring that pulls the eyelids inward, leading to entropion. Other types of conjunctivitis caused by bacterial or viral infections can also result in this condition.
  • Ocular burns and trauma – Trauma to the eye, including chemical injury, can damage the lining of the eye known as the conjunctiva. Scarring of the conjunctiva can cause entropion, wherein the eyelids roll inwards. This condition is more difficult to treat surgically.
  • Epiblepharon – Epiblepharon is common in patients from the east. It is caused by a fold of skin pushing the eyelashes toward the eye surface. It is different from entropion since the eyelid margin rolls inward.
  • Medical Conditions – Rarely, autoimmune conditions such as pemphigoid may cause scarring of the conjunctiva, leading to entropion. This may be treated with immunosuppression to stabilise the condition before proceeding with surgery.
  • Developmental anomalies – Very rarely, babies may be born with the eyelids turned inwards in a condition called congenital entropion.

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What are the risk factors for entropion?

Entropion can develop for several reasons, with the natural weakening of muscles and tissues around the eyelids due to aging being the most common. Previous eye injuries or surgeries may lead to scar tissue that affects the eyelid’s position, while chronic conditions like blepharitis can gradually weaken the eyelid over time. In some rare cases, individuals may be born with structural differences in their eyelids that make them more prone to entropion.

What are the complications of entropion?

Untreated entropion can lead to various complications that impact eye health and comfort. The continuous rubbing of eyelashes against the eye’s surface often results in corneal damage, including abrasions or ulcers, which can cause pain, heightened sensitivity, and potential vision issues. This ongoing irritation disrupts the eye’s protective barrier, increasing the risk of infections like conjunctivitis.
Additionally, the inward-turning eyelid may cause physical injuries to the eye’s surface, sometimes requiring medical intervention to prevent further damage.

Entropion treatment options

Overview of entropion surgery

Surgical correction is often the most effective and long-lasting treatment for entropion, as it addresses the underlying issue by repositioning the eyelid. The specific surgical approach depends on the cause and severity of the condition. At your appointment, our doctors will discuss your medication with you, and you may be asked to stop some medication before entropion surgery.

Before the procedure

A thorough pre-surgical assessment is conducted prior to entropion surgery to ensure the patient’s suitability for the procedure. This evaluation begins with a comprehensive medical history review, during which we will discuss any current medications, previous eye surgeries, and underlying health conditions that could impact the surgery or recovery.
In addition to this review, the surgeon will perform a detailed eye examination to assess the eyelid position, muscle tone, and the extent of any irritation or corneal involvement. This helps determine the most appropriate surgical approach based on the individual’s needs.
Patients are also given specific pre-surgery instructions, including temporarily discontinuing certain medications, arranging post-surgery care, and following hygiene guidelines to minimise infection risks.

During the Procedure

For age-related entropion, surgery usually involves tightening the lower eyelid and repositioning the lid muscles and tendons with stitches under the lower eyelid. This is usually performed under local anaesthesia with sedation. The patient is awake but sleepy for the procedure and the area is numbed with a small injection into the lower lid or eyelid. The whole procedure will usually take around 45 minutes per eyelid. The patient may spend around half a day in the clinic, allowing for preparation and aftercare times.

Entropion caused by scar tissue (cicatricial) is more complex to treat and may require a mucous membrane graft from your mouth. This is usually performed as a day-case surgery under general anaesthesia.

After the procedure, patients are given guidance on recovery, which may involve using prescribed eye ointments, avoiding strenuous activities, and following up with the surgeon to monitor healing. Most patients experience immediate improvement in comfort and appearance, though full recovery may take several weeks. Follow-up visits are often scheduled to ensure optimal results and address any post-operative needs.

Aftercare

After entropion surgery, your eye will be covered with a protective patch or shield to safeguard the area and promote healing. In the initial days following the procedure, it’s normal to experience mild discomfort, swelling, and bruising around the surgical site. To aid recovery, patients are usually advised to use an antibiotic ointment on the area for one week to prevent infection and apply cold compresses to reduce bruising and swelling.
In addition, it’s essential to avoid touching or rubbing the eye and to refrain from strenuous activities, such as heavy lifting or bending, which could place pressure on the healing eyelid. The initial recovery usually spans one to two weeks, though complete healing may take a few weeks. Follow-up visits are essential, allowing the surgeon to monitor your progress and address any questions.

Patients should also be mindful of signs of complications, such as increased pain, redness, or discharge, and promptly contact the clinic if these symptoms appear. With proper aftercare, most individuals achieve a smooth recovery and lasting relief from entropion symptoms.

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Photo focused on the eyes of a woman

Conservative entropion treatment

Conservative therapies provide temporary relief and help prevent eye damage in patients with entropion. However, surgical correction is usually necessary for permanent amendment. Some treatments include:
Artificial tears that help lubricate the eye and reduce irritation and dryness
Soft contact lenses to cover the cornea and prevent further damage
Lubricating eye drops and ointments used regularly reduce lash rubbing
Skin tape to pull the lower eyelid away from the eye temporarily
Quick everting eyelid stitches are applied with local anaesthesia to turn the eyelid outward
Small BoNT injections into the lower eyelid to weaken inward-turning muscles. These injections are effective but need to be repeated every three months to remain effective.

Entropion examples

eyelid entropion
entropion eye
example of entropion
entropion example

FAQ

How to prevent entropion?

While entropion is often age-related and not entirely preventable, specific measures may help reduce the risk.

Wearing safety goggles during activities that may cause trauma can protect the eyes from injury and prevent scarring or damage to the eyelids, which are risk factors for entropion.

Managing chronic eye conditions, such as inflammation or infections, is also beneficial, as these can weaken eyelid tissues over time. Regular eye check-ups with an eye specialist can aid in early detection and management, potentially reducing the risk of entropion developing or worsening.

How much does entropion treatment cost?

The cost of a local anaesthetic entropion repair at The Ezra Clinic starts from £3465, which includes a facility fee of £1965 and a surgeon’s fee of £1500.

What are the possible complications of entropion surgery?

  • Swelling and bruising of the eyelid are common and usually resolve within 10 to 14 days, though the severity can vary.
  • Excessive bleeding may occur, particularly if you are taking blood-thinning medications such as aspirin, clopidogrel, or warfarin. These may need to be paused before surgery, but only with your surgeon’s advice and GP’s approval.
  • Bruising around the eye is possible.
  • Infections of the eyelid or eye socket are rare but can happen.
  • Entropion may occasionally recur, or overcorrection (where the eyelid turns too far outward) may occur, requiring further surgery.
  • Allergic reactions to local anaesthetic or antibiotic drops/ointments are rare.
  • Scarring from the surgery typically blends into the natural skin crease and is barely noticeable, though some individuals may scar more easily than others.
  • If a tissue graft is used, there is a risk it may not fully take, particularly in cases of infection.
  • In rare cases, a tender lump called a granuloma may develop at the wound site. This usually resolves on its own but may need surgical removal if persistent.

How common is entropion?

Entropion is relatively common, especially among older adults. The condition primarily affects individuals over the age of 60 due to age-related muscle and tissue weakening around the eyelid. As people age, the risk of developing entropion increases, making it a reasonably prevalent issue in ageing populations.

Entropion vs. ectropion: what’s the difference?

Entropion and ectropion are both eyelid conditions, but they differ in the direction in which the eyelid turns. Entropion occurs when the eyelid turns inward, causing the eyelashes to rub against the eye’s surface, leading to irritation, discomfort, and potential damage to the cornea.
In contrast, ectropion is when the eyelid turns outward, exposing the inner eyelid to air and irritants. This outward turning can lead to dryness, excessive tearing, and an increased risk of eye infections.

Who does entropion affect?

Entropion primarily affects older adults, individuals over the age of 60 are at the highest risk. Additionally, those with a history of eye injuries, previous eye surgeries, or chronic inflammatory conditions affecting the eyes are more likely to develop entropion. While rare, entropion can also occur in younger individuals due to congenital factors or specific injuries that alter the eyelid structure.