Ophthalmology

Entropion - The inward turning of the lid

Synonyms in a broader sense

Inward curvature of the eyelid rims, eyelid malposition

English: entropion

definition

Entropion is a misalignment of the eyelid, more precisely an inward turn, so that the eyelashes drag on the cornea (so-called trichiasis).
The disease mainly occurs in older age (Entropion senile), but can also occur in babies.

The opposite, i.e. an outward rotation of the lid, is called ectropion.

What are the symptoms of entropion?

The permanent grinding of the eyelashes on the conjunctiva leads to reddening of the patient's eye and a feeling of foreign bodies. This in turn causes frequent squeezing of the eyelids, which can increase the entropion.
The inflamed eye is chronically irritated and normal influences such as light can cause the eyes to squint.

Furthermore, one often observes an increased flow of tears (Epiphora).
Complications are tears (erosions) of the cornea up to ulcers of the cornea (ulcers), an increased risk of infections, new blood vessels and scarring.
Such complications can lead to deterioration in visual acuity.
The entropion disease itself does not primarily lead to a deterioration in vision.

Lash chafing complication

The inward rotation of the lid during entropion causes the eyelashes to rub against the sensitive vitreous humor.
This phenomenon is also known as the so-called epiblepharon.

This leads to a foreign body sensation, also known as trichiasis. This leads to increased itching in the eye and increased tearing. Frequent itching and irritation can also lead to redness.
By scratching the eye with your hands, pathogens can get into the eye and this can lead to inflammation such as conjunctivitis or impaired vision.

How is entropion diagnosed?

The misalignment of the eyelids often allows the diagnosis to be made very quickly.
In addition, the ophthalmologist can use a slit lamp to determine how much the eyelashes rub against the cornea and whether it has already been damaged.

Entropion in the baby

Entropion can also be congenital, but does not necessarily have to have a disease value.
However, congenital entropion is very rare.

Often a baby's eyelashes are still very soft, so turning the eyelid inward does not damage the eye.
As a rule, the newborns only feel slight scratching in their eyes - similar to a foreign body in the eye, so that they itch more often.
Entropion in newborns often occurs together with what is known as distichiasis, a second row of eyelashes.

In most cases, however, treatment is not necessary, as entropion in babies often regresses within the first few years of life.
With complete regression, no further consequences are to be expected.

How is entropion treated?

With a slight entropion that only occurs temporarily, you can put the lid under tension with an adhesive tape on the lower eyelid, so that the edge turns outwards and is brought back into the correct position.

Another only minimal surgical option would be the so-called Schöpfer sutures or Snellen sutures, in which a suture is pulled through the lid, which is then tied with beads and removed after about a week.

When is an operation necessary for entropion?

In more severe cases, some muscle fibers of the orbicularis oculi muscle near the edge of the lid and, if necessary, a narrow strip of lid skin can be surgically removed.

Under certain circumstances, the entropium spasticum can be treated with the neurotoxin botulinum toxin by injection into the orbicularis oculi muscle. However, a long-term effect cannot often be achieved, so that instead of regular injections (around every eight weeks), an operation is generally preferable.

Complications that have already occurred, such as inflammation or scars on the cornea, can be treated with eye drops or eye ointments.

How does an operation work?

In most cases, surgical treatment of the entropion is the only method for long-term relief from the symptoms. The procedure is similar to that of an eyelid lift. The aim is to cancel the inward rotation of the eyelid.
An eyelid lift is a very common operation. During the procedure, the eyelid is shortened and excess fat and muscle tissue is carefully removed. The rest is pulled apart a little and then put back onto the apple of the eye and fixed. In most cases, very thin threads are used so that no large scar remains at the end. The seam is also known as the scoop seam.

The procedure is usually carried out on an outpatient basis and does not require general anesthesia, only local anesthesia.
The operation usually takes about 1-1.5 hours.
The costs are around 1500-2000 €, but are partially covered by the health insurance.

What are the causes of entropion?

The cause is usually a disproportion between the pulling force of the lid closing muscles and the lid opener. With entropium senile there is increased muscle tension (muscle tone) of the orbicularis oculi muscle. Other causes can also be chronic eyelid spasm (blepharospasm) and scars of the conjunctiva (e.g. due to bacterial infections; conjunctivitis). Even with irritation of the conjunctiva, as a result of inflammation of the eye or after an operation, entropium (entropium spasticum) can occur. Scarring of the conjunctiva, for example as a result of an infection, can lead to scar entropion due to shrinkage.

What is the prognosis for an entropion?

The prognosis is good if the eyelid malposition has been corrected early and the cornea has been treated accordingly. Relapses (Recurrences) occur and may require another operation.
Infant entropion often disappears by itself.