Entropion - Causes, Symptoms, and Treatment

What Is Entropion?

Entropion is a condition that manifests itself when the upper eyelid turns inward towards the eyeball. Due to this disease, the skin of the eyelids and the eyelashes constantly rub against one’s eye. The cornea, located at the front of the eye, will typically experience discomfort and irritation due to the friction. The lower eyelid is the most common location for entropion to develop, and the condition can affect either side of the eye. In the absence of treatment, it has the potential to cause damage to the cornea, which could ultimately result in vision loss.

What Is the Complication?

Entropion can irritate the cornea and cause it to become damaged. It is also possible for it to lead to a corneal ulcer, which, if left untreated for an extended period, can result in a substantial reduction in a person's ability to see well. Entropion can result in corneal scarring, leading to the loss of the epithelial layer that covers the cornea's surface in an individual's eye. Lubricating ointments with eye drops can decrease irritation and the risk of harm while an individual is waiting for surgery.

What Are the Different Types of the Condition?

• Involutional or Senile - The most prevalent type is involutional or senile, which develops with age. It is linked to degenerative changes in the muscles that stabilize the eyelid (retractor muscles), as well as a longer tendon that provides tension to the eyelid, which compromises the stability of the eyelid and causes the lower eyelid to invert.

• Congenital: It is linked to genetic and prenatal issues.

• Cicatricial: It develops from an inner eyelid conjunctival scar. In contrast to entropion, where the eyelid is rotated and all the eyelashes brush regarding the eye as a whole, palpebral trichiasis is the loosening of the eyelashes that point towards the eyeball. It can affect both the upper and lower eyelids.

• Blepharospasm - Blepharospasm is the cause of this entropion. It typically affects the lower part of the eyelid and may get worse as people age due to loss of flexibility.

What Are the Symptoms?

• Irritation, as well as the sensation that something is lodged in the eye and excessive watering around the eyes, which is referred to as epiphora crusting or mucous discharge on the eyelid

• Photophobia refers to an eye condition characterized by a painful sensitivity to light.

• Discomfort in the eye to wind, sagging skin around the eye, and redness around the whites of the eye

• Vision issues are another potential complication, particularly if the cornea sustains damage.

What Are the Diagnostic Methods?

1. A biopsy of the conjunctiva should be tested for anti-basement membrane antibodies to rule out an autoimmune disease in individuals with cicatricial entropion or ectropion(a condition that occurs when the eyelid rotates outward (everted) to the point that its edge does not make contact with the eyeball.) and suspected ocular cicatricial pemphigoid (autoimmune ocular disease characterized by severe dry eye syndrome and fibrosis).

2. To detect relative enophthalmos (when an individual's eyes are sunken.) In involutional entropion patients, exophthalmometry (numerous conditions cause the eyeball to appear enlarged as the eye protrudes beyond the bony receptacle or orbit.) is useful.

3. If grafting is needed, individuals with cicatricial entropion (a shortening in the anterior lamella) bring on cicatricial ectropion, which comprises the skin and the orbicularis. The lid border will rotate outward if there is scarring with shortening within the anterior lamella.) They should examine their mouths to detect oral mucous membrane damage and ensure they have enough hard palate or mucus membrane.

What Is the Treatment Method?

1. Medical Treatment

• Entropion patients who refuse surgery may benefit from medical treatment.

• Dry eye syndrome individuals who have spastic entropion may stop the cycle with ocular lubrication with tear preparations.

• Eyelid cleanliness, antibiotics, and corticosteroids treat blepharitis (irritation of the eyelids due to inflammation), which can cause spastic entropion (forceful eyelid closure can lead to a condition known as spastic entropion, which manifests as an inward rotation of the eyelid margin).

• By weakening a pretarsal orbicularis oculi muscle (Horner's muscle is another name for the deep head of the pretarsal orbicularis oculi muscle, which is located in the back of the eye socket.), small dosages of Botulinum toxin can treat spastic entropion.

2. Surgical Procedure

• Quickert-Rathbun Sutures Temporarily: They are useful for spastic and involutional entropion in patients who refuse or are medically unable to undertake more decisive operations. Torque (a metric that quantifies the amount of rotary force that a segment moves) is the eyelid edge away from the globe with full-thickness eyelid sutures (typically gut sutures) from the lesser fornix (a cluster of white matter found in the medial portion of both cerebral hemispheres) anteriorly to the lashes. The eyelid's cicatrix (a scar that develops after a wound has undergone the development and contraction of fibrous tissue) is formed by tissue reactivity to the gut suture.

• Involutional Entropion Fix: Repairing horizontal laxity may involve medial and possibly lateral canthal tightness. Transcutaneously shortening or reconnecting the lower eyelid retractors onto the tarsus's inferior border fixes the vertical component. To prevent tarsus overriding, resect a little piece for the pretarsal orbicularis oculi.

• Fixing Cicatricial Entropion: Scarring, entropion, cicatricial changes, and the tarsal plate affect them. Limited rotation transverse laparotomy cures mild cases. Oral mucous membranes using cadaveric dermis grafts (human cadaver epidermis for medical use when a permanent covering may be applied, excised lesion surfaces are temporarily covered with cadaver skin.) can heal severe scarring. OCP patients must be asymptomatic before conjunctiva-violating surgeries. Conjunctiva manipulation might irritate and fail.

Conclusion

Entropion, also known as the inward bending of the lid margin, can result in a foreign-body sensation, tears, pain, photophobia, and redness. It can also cause corneal scarring, which can lead to a loss of vision that is irreversible. Understanding the differences between the various forms of entropion is essential for managing the illness. The issue can be handled on a short-term basis by using a bandage soft contact lens, epilating the eyelashes, or receiving an injection of Botulinum toxin. In the end, surgical intervention is essential to treat the illness successfully. The patient's quality of life can often be greatly enhanced for the better due to the favorable outcomes of the procedure.