Entropion is a condition in which your lower eyelid turns inward so that your eyelashes and eyelid margin rub against the surface of your eye, causing irritation and discomfort. Your eyelid may be turned in all the time or only turn inward when you blink forcibly or tightly squeeze your eyelids shut. Entropion occurs most often in older adults and is usually not preventable. It is usually caused by weakening of the muscles or tendons in the lower eyelid, scars or previous eye surgery, or infection or inflammation in the eye. Artificial tears and lubricating ointments can help relieve symptoms of entropion, but you’ll often need surgery to correct it. Left untreated, entropion can cause damage to the cornea (corneal breakdown and ulcers), eye infections and vision loss. Usually, entropion can be diagnosed with an evaluation with a surgeon. Your doctor will assess your eyelid’s position on the eye and its muscle tone and tightness to determine your best option for treatment.
Short-term fixes can be useful if you have to delay surgery. Tape can be applied to your eyelid to keep it from turning in. Your surgeon can demonstrate the proper technique and placement of the tape. Stitches that turn the eyelid outward can be done in the office with local anesthesia. After numbing the eye, your doctor places two to three stitches in specific locations along the affected eyelid. The stitches turn the eyelid outward, and resulting scar tissue keeps it in position even after the stitches are removed. However, there is a high likelihood that your eyelid will turn itself back inward within several months of the stitching.
Entropion usually requires surgery. The technique used depends on the cause of the entropion and the condition of the surrounding tissue. Before the surgery, you’ll receive a local anesthetic to numb your eyelids. If your entropion is caused by muscle and ligament relaxation due to aging, your surgeon will likely perform a technique to tighten the tendons and muscles of the lid. You’ll have a few stitches on the outside corner of your eye, or just below your lower eyelid.
Ectropion is a condition in which your lower eyelid turns out. This leaves the inner eyelid surface exposed and prone to irritation. Ectropion is more common in older adults. Normally when you blink, your eyelids distribute tears evenly across your eyes, keeping them lubricated. These tears drain into the little openings on the inner part of your eyelids. When you have ectropion, your lower lid pulls away from your eye and tears don’t drain into the puncta properly. This can cause you to have eye irritation, burning, redness of the eyelid and the white part of your eye, excessive watering (tears pool and then can flow over your eyelids), and excessive dryness of the surface of your eye. Some common causes on ectropion are muscle weakness, facial paralysis, scars or skin problems, eyelid growths, radiation treatment, or previous surgery. Your doctor will assess your eyelid’s position on the eye and its muscle tone and tightness to determine your best option for treatment.
There are several different surgical techniques for ectropion, depending on the cause and the condition of the tissue surrounding your eyelid. Before the surgery, you’ll receive a local anesthetic to numb your eye and the area around it. You may be lightly sedated using oral or intravenous (IV) medication to make you more comfortable, depending on the type of procedure you’re having and whether or not the surgery is performed in an outpatient surgical clinic.
If your ectropion is caused by muscle and ligament relaxation due to aging, your surgeon will likely use a technique to tighten the tendons and muscles of the lid, causing the lid to rest properly on the eye. You’ll have a few stitches on the outside corner of your eye or just below your lower eyelid. In many cases, this procedure is relatively simple and will be the only surgery you need. If you have facial paralysis or significant scarring, the outcome of surgery is less predictable, and more than one procedure may be necessary.
Following your surgery, you may need to use an antibiotic and steroid drop or ointment on your eye several times a day. You may also use cold compresses periodically to decrease bruising and swelling.
At first your eyelid might feel tight, but as you heal, it will become more comfortable. For most people, ectropion symptoms are relieved immediately after surgery. You will get your stitches removed about a week after your surgery, and you can expect the swelling and bruising to fade in about two weeks.