Types of entropion

There are four main types of entropion; the age-related type is the most common. Entropion is where the eyelid turns in, and the lashes touch the eye.  As an ophthalmologist and an oculoplastic surgeon, I deal with all four types of entropion.
The categories of entropion are as followed:

• Congenital entropion
• Spastic
• Involutional or age-related
• Cicatricial entropion

The names of these types of entropion relate to their causes; someone who has a congenital entropion is born with an eyelid turning inwards. Congenital entropion is quite unusual.
The second type of entropion is more common; spastic entropion.  That happens when something gets in the eye and is an acute very forceful closing of the eye, which manages to turn the eyelid inwards and the lashes then touch the cornea.  The resulting effect is a worsening of the squeezing of the eye and more turning.  Sometimes spastic entropion has to be treated with local anaesthetic drops and followed by botulinum toxin injection into the muscle that is turning and the additional treatment of the foreign body.
The third type is related to older age which is by far the most common cause of entropion and is called involutional or age-related entropion.  That happens in older people from the age of about 60 onwards.  The connections between the eyelid structures, the muscles and the little fascia become loose, and the eyelid becomes laxer so it destabilises and contraction of one of the eyelid closing muscles overrides a muscle higher up on the lid and turns the lower lid inwards. Eyelid surgery is the best treatment for involutional entropion.
Lastly, there is cicatricial entropion, and that is caused by scarring on the inside of the lid, and that can happen as a result of chronic dry eyes, blepharitis, shingles, viral conjunctivitis and other medical causes such as cicatricial ocular pemphigoid.
In summary of the four causes congenital, spastic, involutional and cicatricial:

• Congenital entropion is rare
• Spastic is usually temporary
• Involutional entropion happens as you get old and the treatment is surgical
• Cicatricial is more complex with multiple causes.  The treatment of cicatricial depends therefore on its specific cause and can be harder to treat if it is from pemphigoid and requires a specialist ophthalmic opinion.

As an oculoplastic surgeon, I do entropion eyelid surgery at Clinica London regularly.  I have over 30 years experience of eyelid surgery for functional eyelid problems such as entropion.
Involutional entropion surgery is done as a day case under local anaesthetic. It involves a few strategically placed stitches and eyelid tightening. After the surgery, the eye is padded up for a day before the patient can start putting in eyedrops and ointment. Stitches are taken out between one and two weeks later. The success rate of surgery is over 95%.