Entropion (eyelid malposition): causes, symptoms & treatment

What is an entropium? Definition and meaning

Entropion (ICD-10 H02.0) is a pathological inward turning (inversion) of the eyelid margin, which predominantly affects the lower eyelid and, less commonly, the upper eyelid. As a result of this malposition, the eyelashes come into direct contact with the cornea and the conjunctiva, leading to continuous irritation (trichiasis).

The aim of treating entropion is to restore the eyelid to its normal anatomical position, so that the eyelashes no longer rub against the eye. This is intended to alleviate the associated symptoms, protect the surface of the eye from further damage and preserve vision.

Causes: How does an entropium develop?

• Involutionary entropy (senile entropy): The most common form, which occurs in older age. It is caused by age-related sagging of the eyelid structures, in particular instability of the lower eyelid retractors (the muscles that pull the eyelid down), horizontal eyelid sagging, and overactivity or slippage of the pre-septal portion of the orbicularis oculi muscle (the muscle surrounding the eye).
• Scarring entropion (entropion cicatriceum): This is caused by scar tissue pulling on the inner surface of the eyelid (tarsal conjunctiva). Causes may include injuries, burns, chronic inflammation (e.g. trachoma, Stevens-Johnson syndrome) or previous operations. The scar shortens the inner lamella of the eyelid and pulls it inwards.
• Spastic entropion: A temporary inward turning of the eyelid caused by a spasm of the orbicularis oculi muscle, often triggered by eye irritation, inflammation or following eye surgery.
• Mechanical entropy: Rarely, due to tissue changes or tumours that push the eyelid inwards.

Congenital vs. acquired entropium: distinctions

It is important to distinguish between congenital and acquired entropion:

• Congenital entropion (entropium congenitum): This is a rare form that occurs at birth or shortly afterwards. It is often caused by a developmental abnormality of the eyelid structures, e.g. a malformation of the eyelid retractors or an abnormal eyelid fold (epiblepharon), in which a fold of skin presses the eyelashes against the eye. It more commonly affects the lower eyelid and can sometimes resolve spontaneously during the first year of life.
• Entropium acquired: These are all the forms mentioned above (involutional, cicatricial, spastic, mechanical), which arise over the course of a person’s life due to various causes. Of these, involutional entropion is by far the most common form.

This distinction is relevant to the choice of treatment and the prognosis.

Symptoms: How can you tell if you have entropion?

The symptoms of entropion are primarily caused by mechanical irritation of the surface of the eye resulting from the eyelashes turning inwards:

• Foreign body sensation: The feeling as if there were always something in my eye.
• Redness and irritation of the eyes
• Tearing (Epiphora): In response to the irritation.
• Sensitivity to light (photophobia)
• Eye pain
• Blurred vision: Due to irritation of the cornea or an increased tear film.
• Frequent blinking or squinting
• Mucus secretion
• Visible inward rotation of the eyelid margin and the eyelashes

Risks and possible complications of untreated entropion

If entropion is left untreated, the constant rubbing of the eyelashes against the cornea can lead to serious complications:

• Corneal abrasions (erosions)
• Corneal inflammation (keratitis)
• Corneal ulcers (ulcus corneae)
• Scarring of the cornea
• The growth of blood vessels into the cornea (neovascularisation)
• Chronic conjunctivitis
• Long-term deterioration in eyesight in severe, untreated cases, this can even lead to blindness

For these reasons, prompt treatment is essential.

Treatment: What should you do if you have entropion?

The aim of treatment for entropion is to eliminate irritation of the surface of the eye and to restore the correct position of the eyelid.

Conservative and temporary treatment options

• Tear substitutes: For moisturising and protecting the surface of the eye.
• Eye ointments (especially at night)
• Pulling the lid out using adhesive tape: A temporary measure to pull the eyelid outwards.
• Removal of irritating eyelashes: It’s only a short-term solution, as the eyelashes will grow back.
• Therapeutic contact lenses: As a contact lens to protect the cornea.
• Botulinum toxin injections: Can help to relieve muscle spasms in cases of spastic entropion.

Surgical treatment

The definitive treatment, particularly for involutional, cicatricial and often also congenital entropion, is surgical. The choice of surgical technique depends on the cause and extent of the entropion:

• In the case of involutional entropium: Surgery is frequently performed to tighten the horizontal eyelid ligaments (e.g. lateral tarsal strip plasty), reattach the lower eyelid retractors or place an eversion suture (e.g. according to Hotz or Wies) to rotate the eyelid outwards.
• In cases of cicatricial entropion: The scar must be released and, if necessary, the shortened inner lamella of the eyelid must be lengthened using a graft (e.g. oral mucosa, tarsus).
• In the case of congenital entropion: Often, a simple eversion suture or a small excision of the excess skin fold is sufficient. The procedures are usually carried out under local anaesthesia and can often be performed on an outpatient basis.

Aftercare and recovery period following surgical correction

• Aftercare: Immediately after the operation, the eye is usually covered with an ointment dressing. Antibiotic and anti-inflammatory eye drops or ointments are applied. Applying a cold compress can help reduce swelling. The stitches are removed after around 7–10 days.
• Recovery time: Mild swelling and bruising are normal and will subside within 1–2 weeks. Most patients are able to resume their social and working lives quickly. The final result will be visible after a few weeks.

Cost coverage and insurance

Surgical correction of entropion is generally a medically indicated procedure, as the condition leads to functional symptoms and potential damage to the surface of the eye. Consequently, provided there is a corresponding diagnosis and symptoms, the costs of the operation are usually covered by both statutory and private health insurance schemes. It is nevertheless advisable to clarify cover with your health insurance provider in advance.