Entropion illustration - Turned In Eyelids (1)

ENTROPION

 

What is entropion?

Entropion is one of the most common eyelid problems, especially among East Asians. It is a medical condition in which the eyelid (usually the lower lid) folds inwards.

What are the symptoms of entropion?

It is very uncomfortable, as the eyelashes continuously rub against the cornea causing irritation. Entropion symptoms often develop slowly, starting out as just a mild eye irritation. As the eyelid rolls inward, the eyelashes start to scratch your cornea. Over time, repeated scratches to your cornea can lead to:

·     eye redness
·     watery, teary eyes
·     infections of the cornea
·     scarring
·     loss of vision

If untreated it can lead to ulceration of the surface of the eye, followed by scarring which could cause loss of vision. It is thus important to have this condition treated before these complications permanently damage the eye.

Entropian in Asian Eyes example


 

What are the causes of entropion?

Entropion has a number of causes, although it is usually caused by laxity of the tissues that support the lower eyelid. This results in the inward rolling of the eyelid margin.  

Occasionally it can be due to genetic factors. It can also be due to scarring of the inner surface of the eyelid caused by inflammation or chronic infections.

What is the treatment for entropion?

In most cases, surgery will be required to tighten the lower eyelid and its attachments, which will help reposition it back to its normal position.

If you wish to delay surgery, temporary relief can be achieved by gently pulling and taping the eyelid to the outside of the eye. This creates tension that causes the eyelid to flip away from the surface of the eye.  Repeated using of the tape can cause skin abrasions and dermatitis.

Botox/filler injections may be used to achieve the same result, to weaken the muscles that are pushing the lid inwards. Lubricant and antibiotic eye drops can also be used. Unfortunately, these measures do not result in a permanent cure.

If both entropion and cataract are present in the same eye, it is best to have the entropion corrected before the cataract surgery.  


 

What types of operation are there for lower lid entropion?

Approaches to lower eyelid entropion correction, this includes:

– Everting Sutures  (Minimally invasive)
Stitches are placed in the eyelid to stiffen it and stop it from turning in. This is a quick operation, which can be carried out on both lower lids at the same visit.  The success rate is high but results are usually temporary.  The procedure is done in emergency cases where the cornea is already infected or the patient is not suitable for surgery.

– Eyelid and Retractor tightening

It takes about 45 minutes. A cut is made in the skin of the lid and deep stitches put in to tighten the muscle, which opens the lid (the lid retractor). The success rate is high and results are long-lasting and permanent.

During your consultation, Dr. Vanessa will examine your situation and provide you with the best options of treatment that suits your needs.

How about surgery options for upper lid entropion?

– Anterior Lamellar Reposition

Upper eyelid entropion also tends to be common among  East Asians due to the underlying structure of  Oriental eyelids which tend to be puffy with the absence of lid crease.  As we age the overlying skin tends to droop which pushes the eyelids and eyelashes inwards.

A cut is made in the skin of the upper lid and eyelid is lifted and puffiness (excess fat) reduced. Several stitches are put in to turn the edge of the lid outwards.  The surgery eventually results in outward turning of the eyelashes along with the eyelid looking less puffy and rejuvenated. The operation takes about 45 minutes.

What are the risks of entropion surgery?

Entropion surgery is considered a minor surgery and does not require hospital stay. It is generally a safe and a low-risk surgery. It should be treated by Ophthalmic Surgeons who are trained to manage it.

You may experience:
·      Discomfort and bruising in the lids
·      Infection of the eyelids. This is extremely rare but if it does occur the stitches may loosen so that sometimes a gap develops in the lid. The lid will often still heal well especially if antibiotic tablets are given but may take longer to settle down.

Rarely, the lid starts to turn outwards after the operation.  Massaging or removing the stitches early may help this to settle.


 

What about consent for the operation?

Before any operation, usually on the day of surgery, you will be asked to sign a consent form.

When you sign the consent form you are indicating that you want to go ahead with the operation. If you are not happy with anything on the form you should not sign it until you have had your worries discussed and resolved.

What happens after the operation?

You will be provided with an eye pad, leave it on for at least 1 hours – this will help to reduce bruising.

You can clean the eyelids using a cotton wool gently with boiled water that has cooled down. You will be provided with an ointment to apply, use it as instructed.

It is normal for the eyelids to appear swollen and bruised for the first week or so.  If your eyelid feels sore when the anesthetic wears off, you can take painkillers which will be prescribed. The discomfort usually settles within one or two days.

Stitches need to be removed after one week.


 

If you experience the following symptoms, please make an appointment to see us and we can help you address this uncomfortable situation.

 

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