An entropion is the medical term for an inward sweep of the eyelid. It results in the eyelashes dragging steadily on the eye. Most often, entropion affects the lower eyelid.
What is entropion?
Entropion is a malpositioning of the eyelid. The eyelid is turned inward. Because of this inward sweep of the eyelid, the eyelashes always drag on the cornea as well as the conjunctiva. The acquired or congenital disease can be divided into four different forms: age-related entropion, cicatricial entropion, congenital entropion and eyelid spasm. The typical symptoms are an inwardly turned eyelid edge and rubbing eye lashes. The constant rubbing causes further concomitant symptoms such as reddened and occasionally partly purulent-mucous clogged eyes. As a result, those affected often squeeze their eyes shut, which intensifies the irritation and the resulting discomfort. If entropion persists for a prolonged period of time, scarring, ulceration, and inflammation may occur, which in turn negatively affect the visual acuity of the diseased eye.
Causes
There are many causes of entropion. Most often, there is a disproportion in the traction of different eyelid muscles. This disturbed relationship occurs mainly with increasing age. Scars on the conjunctiva of the eyelid can also cause entropion. In this case, the condition is often accompanied by bacterial eye inflammation. In addition to acquired reasons for this inward turning of the eyelid, there are also congenital eyelid malpositions. This usually occurs when the infant’s eye is too small or the suspensory apparatus on the lower eyelid is not sufficiently developed. A so-called eyelid spasm can also cause this condition in the eye. In this case, the fibers of the annular eyelid muscle near the lid are persistently contracted. This condition causes a temporary entropion or may exacerbate an existing entropion.
Symptoms, complaints, and signs
Inward retraction of the eyelid causes various unpleasant symptoms to the eyes of the affected person. However, this condition can usually be treated well, so there are no particular complications or serious discomfort in the process. The affected person primarily suffers from an eyelid edge that is bent inward. This results in a permanent foreign body sensation in the eye, which can have a very negative effect on the patient’s quality of life. Likewise, eyelashes increasingly enter the eye, which can lead to pain or a watery eye. Itching also occurs and can therefore lead to reddened eyes. If the inward sweeping of the eyelid is not treated, the discomfort can permanently damage the eye, causing various visual problems or even vision problems. In some cases, treatment of this complaint is not even necessary, as self-healing very often occurs. Furthermore, the inward turning of the eyelid can also have a negative effect on the aesthetics of the affected person. This can eventually lead to depression or various other psychological upsets. However, the life expectancy of the affected person is not negatively affected by the inward sweep of the eyelid.
Diagnosis
The conspicuous position of the eyelid usually allows a very quick diagnosis of entropion. The edge of the diseased eyelid is turned inward, so that the eyelashes constantly rub against the eye. In addition to simple eye diagnosis, a so-called slit lamp can be used for diagnosis. This instrument allows the ophthalmologist to determine the extent of the inward sweep onto the eye. If the treating physician was able to detect the disease at an early stage, a favorable course is likely. If the cause is congenital, the misalignment often regresses on its own. If the inward inversion is more pronounced or already chronic, it can be permanently corrected with consistent treatment methods. Rarely does the deformity recur after surgery. If entropion is not treated, vision may be impaired or the affected eye may go blind.
Complications
In most cases, the patient suffers from an uncomfortable foreign body sensation in the eye due to the inward sweep of the eyelid. This foreign body sensation often causes the affected person to reach into and rub the eye with their fingers.This can cause infections and inflammations to develop, which can lead to secondary damage and other diseases. Likewise, the eyes are reddened and may also water. The symptoms limit the quality of life and in many cases the patient can no longer concentrate. It is also no longer possible to carry out various tasks and activities without further ado. Early treatment is possible because the diagnosis is relatively simple and uncomplicated. The further course of the inward sweeping of the eyelid also depends strongly on the cause of the symptom. In most cases, no surgical intervention is necessary. However, if the inflammation is severe, surgical intervention is necessary. Likewise, the patient is dependent on eye drops or ointments to assist in treatment. Life expectancy is not reduced by inward retraction of the eyelid.
When should you see a doctor?
If the edge of the eyelid is turned inward, it is probably entropion. A visit to the doctor is necessary if the conspicuous position of the eyelid has not receded after one to two days at the latest. If other symptoms are present and the conjunctiva is severely irritated, for example, a specialist must be consulted on the same day. The same applies if the disease is accompanied by a bacterial inflammation of the eye or if there is a serious underlying cause. Entropion that occurs after eyelid spasm must be examined and treated immediately, otherwise further complications may develop. Congenital or chronic deformities should also be seen by an ophthalmologist. If the symptoms are severe, it is best to go to the nearest hospital or a specialized clinic for ophthalmology. With children, elderly and sick people should definitely visit the ophthalmologist‘s office immediately due to possible secondary symptoms. Depending on how severe the entropion turns out to be, a longer lasting medical monitoring is required afterwards.
Treatment and therapy
The method of treatment for entropion depends critically on the extent of the eyelid malposition. Furthermore, the cause of the inward reversion is decisive. If it is a mild entropion, which, for example, has arisen due to inflammation, a sticking plaster strip attached to the lower eyelid is often already sufficient as a form of therapy. Alternatively, the eyelid can be fixed with a scoop suture. If the inward sweeping is more severe or chronic, surgical intervention may be necessary. This involves shortening the eyelid and removing excess muscle. If the condition of the diseased eye does not improve despite various treatments, a therapeutic contact lens may prove helpful. The artificial lens keeps the eyelashes away from the cornea, preventing the eyes from becoming severely irritated. To treat the possible changes in the cornea caused by inward sweeping of the eyelid, application of ophthalmic ointments may be necessary. If the malposition is congenital, usually no special therapy is necessary. The eyelashes in infants are still very soft, so no damage to the cornea is to be expected. Often, congenital entropion recedes within the first two years of life without treatment.
Outlook and prognosis
With age, entropion, an inward turning of the eyelid, may occur. However, this phenomenon may also be congenital. It often regresses on its own in this case. The situation is different in the case of an entropion that developed later. In this case, surgery is often necessary under local anesthesia. The problem is that the success of the operation can only be prolonged if it is treated at an early stage. In this way, entropion recurrences can often be prevented. Often there is a relapse some time after an operation that was successful in itself. The inward reversion of the eyelid occurs again. This causes considerable discomfort. A recurrence worsens the prospects of experiencing permanent relief from the symptoms. Only in cases of congenital inward inversion of the eyelid and early surgery the prognosis is good. The reason for the worse prognosis is to be found in the operation itself. Entropion surgery is relatively complex. It involves horizontal shortening of the affected eyelid. For this, parts of the eyelid skin and the muscles moving it below the eye have to be removed. This operation does help to prevent the eyelid from turning inward.But at the same time it weakens the ring-shaped sphincter muscle through which the eyelid protects the eye. For this reason, the prognosis worsens in case of recurrence. Another operation further weakens the sphincter muscle.
Prevention
There are no preventive measures for entropion or inward reversion of the eyelid. All that can be done is to try to avoid infection and injury to the eyes. Otherwise, the resulting scars could subsequently lead to cicatricial entropion. Since entropion can also be congenital, preventive measures are thus severely limited.
Aftercare
In most cases, when the eyelid is inverted, the affected person has no particular options for aftercare. In this case, the affected person is first and foremost dependent on medical treatment of this complaint to prevent further complications. Since it cannot heal on its own, immediate and rapid treatment is also usually advisable in order to prevent further complaints. The sooner a doctor is consulted in the event of inward retraction of the eyelid, the better the further prognosis of this condition usually is. In most cases, the exact type of treatment depends on the exact symptoms and their severity. In some cases, surgical interventions are necessary to alleviate these complaints. After such a surgical intervention, the affected person should always rest and take care of his or her body. Efforts or other stressful and unnecessary activities should be avoided in any case. In some cases, ointments can also be helpful, and the affected person should make sure to apply them regularly. The life expectancy of the patient is not reduced by this disease in most cases. Furthermore, wearing contact lenses can also be helpful in limiting the discomfort.
What you can do yourself
Self-help measures for this eyelid malposition are possible to a limited extent and should be implemented in consultation with the attending physician. In the case of reddened eyes, it is important for those affected to refrain from using cosmetic items in the eye region. If there is a need to hide the optical blemish of the malposition with natural aids, it is advisable to use glasses with window glass. Sufficient tear fluid should be ensured. If the eyes are too dry, eye drops should be used. Itching and rubbing of the eye should always be avoided. Pathogens can otherwise enter the organism through the open areas and trigger further illnesses. For a good emotional and mental handling of the disease, the affected person often needs measures to strengthen self-esteem. Situations can be created in which a sense of achievement is built up. The patient should focus on his or her strengths so that entropion does not become the center of life. In addition, an open approach to the disease and its symptoms helps. If the patient is aggressive, the deformity is less likely to be noticed by outsiders. For inner composure and stress reduction in everyday life, relaxation techniques additionally help.
