Entropion: causes and treatments

Entropion is a condition where the eyelids turn inwards, and the eye can become very sore because the lashes touch the surface of the eye.  Entropion treatment, which occurs largely in older people, the options are first of all lubricant drops and ointment for immediate symptomatic relief, Botulinum toxin to stop the eyelid turning in, and lastly surgery.
When I see patients with entropion, I have to assess whether they have constant or intermittent entropion and if there have been some scratches caused by the lashes on the front of the eye.  Unfortunately, when the lashes turn in towards the eye, as we all know, it gives a foreign body sensation and so an acute spasm is induced which makes the patient squeeze their eyelids closed more and of course turns in the lashes more.  All this exacerbates the discomfort and can lead to a keratitis and a constant entropion.
To break the cycle, we need to do surgery. If surgery cannot be done immediately and say the patient has to wait a few weeks before it can be done as for instance in the NHS, then a small shot of Botulinum toxin into the perceptual orbicular muscle can help. Placed strategically, the Botox will stop the orbicular muscle (eyelid closing muscle) from overriding what is called the perceptual orbicular muscle, and cause the eyelid to turn in. Although this might seem complicated, it is in fact quite a simple injection. It takes a week to start working, so therefore it doesn’t take immediate effect.  If used in a very small dose it has a good response without any complications or side effects.  The only complication or side effect of Botox for entropion is slight discomfort with the injection and possibly a minuscule bruise when the dose is used in the right amount and placed in the right part.
Entropion treatment is best done by oculoplastic surgeons who are trained in the anatomy and function of the eyelids and their surgical correction.  The principle is to shorten the lids for there to be no eyelid laxity horizontally and subsequently to place strategic everting sutures to turn the eyelid outwards.
The surgery is always done under local anaesthetic as a day case, and it can even be done quite simply in a nursing home or at the patient’s bedside if they are quite sick, by using the simple everting sutures.  However, for a longer and more lasting effect, most of the studies have shown that results of at least 95% success are achieved when the eyelid is both shortened and turned outwards surgically.
The results of entropion surgery are indeed very high, and it is well worth having this done, rather than put up with the eyelid turning in. Entropion is a significant eyelid problem which requires eyelid surgery. Eyelid entropion is particularly noticeable and troublesome on reading and looking down which can be worse when reading at night in bed.
Surgery is done here at Clinica London under local anaesthetic and takes about 30 minutes.  The surgery is done with the patient either sitting up slightly or lying flat on a very comfortable couch in our minor operating room.
In the next blog, I will tell what is involved with the surgery so that you can prepare either yourself or one of your relatives in advance of entropion surgery.