Involutional Entropion of the Lower Eyelid

Creator: Dr. Lincy Varghese
Published: 2023-03-31T18:41:00

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Involutional entropion is a medical condition of the eye characterized by the lower eyelid margins folding inward towards the globe.

Written by

Dr. Lincy Varghese

Medically reviewed by

Dr. Asha Juliet Barboza

March 31, 2023

November 24, 2023

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Contents

What is Involutional Entropion?
What Causes Involutional Entropion?
What Are the Signs and Symptoms of Involutional Entropion?
What Are the Diagnostic Tests for Involutional Entropion?
What Are the Treatment Options Available for Involutional Entropion?
What Are the Complications of Involutional Entropion?
Can Involutional Entropion Be Prevented?

Introduction:

Human eyelids containing a row of eyelashes play a significant role in protecting from foreign bodies, dust particles and maintaining ocular surface moisture of the eye. Eyelashes are a feature shared by all animals, indicating that they have evolved to be advantageous for survival over millions of years. The eyelid comprises two main components; they are anterior lamella and posterior lamella. The anterior lamellar constitutes eyelashes, skin, glands, orbicularis oculi muscle. The tarsal plate, conjunctiva, and retractor muscles are the components of the posterior lamella. Entropion development primarily depends on the orbicularis oculi muscle and the posterior lamella.

What is Involutional Entropion?

Involutional entropion is a medical condition characterized by the lower eyelid margins folding inward towards the globe. As a result of this condition, the skin of eyelids and eyelashes pushes towards the eye, causing discomfort and irritation to the eye. Involutional entropion is commonly seen in lower eyelids and may also affect one or both sides of the eye (bilateral entropion). This condition is frequently seen in persons above the age of 60 years. Ectropion is the reverse side of this condition in which the eyelid folds outward. If this condition is left untreated, it may affect the cornea and cause vision loss.

What Causes Involutional Entropion?

The involutional entropion can be caused by:

Aging - Entropion can result from aging. As a person ages, there is more sagging skin around the eyelids, the muscles behind the eyes weaken, and the tendons and ligaments in the region loosen.
Scars - Scarring may result from trauma, chemical burns, or radiation to the face, leading to a change in the eyelid's natural curvature.
Bacterial Infection - A bacterial infection such as trachoma, a contagious disease that spreads from person to person through towels or dresses. Trachoma can leave a rough and scarred appearance on the inner layer of the eyelids and may cause the development of involutional entropion.
Congenital Problems - An additional fold of skin on the eyelid at birth that results in turned-in eyelashes may cause congenital entropion.
Surgery - After eye surgery, eyelid spasms may occur, leading the eyelid to turn inward.

What Are the Signs and Symptoms of Involutional Entropion?

The signs and symptoms of Involutional entropion include:

Discomfort and irritation of the eye.
Redness.
Feeling like there is something in the eye.
Eye pain.
Watering of the eyes (excessive tears).
Burning sensation.
Itchiness.
Blurry vision.

What Are the Diagnostic Tests for Involutional Entropion?

The diagnostic tests for involutional entropion include:

Routine Eye Examinations - Involutional entropion can be diagnosed through a routine eye examination. The doctor may ask about the possible causes, such as trauma, surgery, or eye injuries.
Snap Back Test - During the snap back test, the doctor may pinch the eyelid up and down and analyze how fast the eyelid may revert to its normal position. This test confirms the visual diagnosis if collagen and muscle tone are lost.
Eyelid Distraction Test - During the test, the doctor pinches the lower eyelid, pulls it anteriorly away from the globe, and then measures how far the lower eyelid's margin was from the globe.
Digital Eversion Test - In the digital eversion test the doctor pulls the patient's eyelid downward and asks them not to blink and confirms the test.

What Are the Treatment Options Available for Involutional Entropion?

A doctor can determine the most efficient treatment for entropion by determining its underlying cause.The treatment options available for involutional entropion include:

Botulinum Toxin Injections (Botox) - By giving botulinum injection, the lower eyelid muscles can be relaxed and prevented from tightening inward. This injection may provide symptom relief for another three to four months.
Eye Drops - Topical lubricating ointments and eye drops provide quick relief for discomfort and eye irritations in mild cases.
Contact Lenses - The doctor may advise wearing contact lenses to prevent eye irritation. Contact lenses act as a barrier between the entropion eyelid and eye by preventing rubbing of the eye.
Transparent Tapes - The inward folding of the eyelid can be prevented by applying transparent skin tape. The patient learns to apply the tape with the pointed end on the upper cheek and the other towards the lower eyelashes.
Surgery - Surgery can provide a long-term correction. There is a 50 % to 80 % success rate for surgical entropion therapy. The muscles surrounding the eyelids must be tightened surgically. Surgery can be performed in a hospital emergency room using a local anesthesia. During the surgery, the stitches are used to tighten and turn the eyelid back outward. The doctor may advise using eye drops and an eye patch overnight after surgery to protect the eye. Following entropion surgery, most patients report brief side effects, such as swelling and bruising. These signs of recovery are common, but they can be controlled with medicines and cold compresses.

What Are the Complications of Involutional Entropion?

The complications of involutional entropion includes:

Corneal ulcer.
Corneal abrasions, a minor scratch on the transparent, protective "window" at the front of the eye (cornea).
Eye injuries.
Permanent blindness.

Can Involutional Entropion Be Prevented?

Involutional entropion is challenging to prevent as it occurs with aging or after scarring. Wear protective eyewear during activities to lower the risk of getting involutional entropion problems. Consult a doctor immediately for an evaluation and treatment if the eyes start to feel itchy and red after visiting a place where trachoma infections are widespread. Make an appointment with a doctor who feels like there is always something in the eye or observes that some of the eyelashes are pointing inward toward the eye.

Conclusion:

Involutional entropion is a medical condition characterized by the lower eyelid margins folding inward towards the globe. As a result of this condition, the skin of eyelids and eyelashes pushes towards the eye, causing discomfort and irritation to the eye. It is simple to diagnose entropion. A doctor can determine the most efficient treatment for entropion by determining its underlying cause. Even if nonsurgical treatments are effective in the short term, surgery is ultimately necessary to treat entropion. Once the treatment is done, the results are typically excellent. Surveys of patients conducted after they recovered from the surgery revealed a significant improvement in their quality of life.

Frequently Asked Questions

1. How Should Involutional Entropion Be Treated?

Surgery is often used to cure involutional entropion, which is the inward twisting of the eyelid brought on by aging and loosening of the eyelid tissues. Surgery may entail several treatments to address the underlying problem, including tissue repositioning, canthoplasty to tighten the outer corner of the eyelid, or the excision of extra tissue. The degree and nature of the entropion determine the surgical method to be used. While non-surgical methods like lubricating eye drops may provide short-term comfort, surgery is frequently the most efficient way to make a lasting improvement.

2. Is It Possible for Entropion to Resolve Without Surgery?

Temporary alleviation from entropion in moderate instances may be possible without surgery. These methods include lubricating eye drops or ointments, temporarily taping the eyelid to stop it from rolling inward, or administering muscle relaxants to relax the muscles temporarily. It's crucial to remember that these non-surgical treatments do not provide a long-term fix. Surgery is frequently required for a long-lasting repair and to avoid probable entropion problems.

3. Which Surgical Procedure Is Considered the Most Effective for Entropion?

The underlying etiology and the severity of the ailment, as well as other variables, influence the surgical approach chosen to treat entropion. Involutional entropion is frequently thought to be very responsive to canthoplasty, a surgical procedure that tightens the outside corner of the eyelid. For cicatricial or congenital entropion, different surgical treatments could be better. The eye doctor or ophthalmologist will evaluate the specific circumstances and suggest the best surgical course.

4. Can Entropion Lead to Vision Loss?

While entropion does not in and of itself cause blindness, it might result in visual issues if neglected or if it worsens. The continual rubbing and irritation of the eyelashes against the cornea can cause ulcers, scarring, and corneal damage. These disorders have aTseveren eyesight. In order to avoid the long-term visual difficulties linked to entropion, prompt treatment is essential.

5. What Are the Potential Consequences of Leaving Entropion Untreated?

Failure to handle entropion may have a number of negative effects. Constantly moving the eyelid inward can cause corneal scarring and damage, chronic eye discomfort and recurring infections. Vision impairment and pain may eventually result from this corneal injury. To avoid these potential effects and maintain ideal eye health, it is crucial to seek therapy for entropion.

6. What Is the Expected Post-Surgery Recovery Period for Entropion?

Individual recovery times for entropion surgery can vary, but generally speaking, patients should allow several weeks for full recovery. The eyelid may initially swell and bruise, and it can take some time for it to settle into its new position. It's essential to carefully follow the surgeon's post-operative care recommendations to guarantee a speedy recovery and the finest results.

7. What Diagnostic Methods Are Used to Identify Involutional Entropion?

An ophthalmologist or other eye expert will do a clinical examination to determine whether involutional entropion is present. The healthcare provider assesses the physical symptoms and indicators, such as the inward bend of the eyelid, the placement of the eyelashes, and any accompanying discomfort, during this examination. To diagnose and measure the degree of involutional entropion, this clinical evaluation is often sufficient.

8. Is There a Permanent Cure for Entropion?

Surgical correction is frequently an effective long-term treatment for entropion. Surgery aims to treat the underlying problem, whether it's brought on by scarring (cicatricial), aging (involutional), or other factors, and return the eyelid to its natural position. Entropion can be permanently by surgical procedures that are intended to give long-term relief from the condition.

9. Does Entropion Have Any Connection to Glaucoma?

Glaucoma is a distinct eye ailment marked by elevated intraocular pressure, and it is not directly related to entropion. However, persistent ocular irritation and corneal damage brought on by entropion may unintentionally aggravate glaucoma in people who already have the condition. In order to avoid any potential worsening of glaucoma symptoms, early intervention and treatment of entropion are crucial.

10. What Sets Cicatricial Entropion Apart from Involutional Entropion?

The basic causes of cicatricial entropion and involutional entropion are different. While cicatricial entropion generally results from scarring, frequently from prior trauma, injury, or surgery, involutional entropion is typically due to aging and the natural relaxing of eyelid tissues. The distinction between the two is essential because, depending on the underlying reason, different treatment strategies may be used. For instance, surgery for cicatricial entropion frequently entails removing the scar tissue.

11. What Complications Might Arise from Entropion Surgery?

While entropion surgical risks are uncommon, they might include infection, bleeding, or the problem returning. Although there is a chance of infection at the surgical site, the risk is often reduced with appropriate pre- and postoperative care. Although little bleeding after surgery is typical, severe bleeding is rare. Although uncommon, entropion recurrence may necessitate further surgical treatment. Before treatment, the surgeon will review possible hazards and safety precautions to guarantee the greatest outcome.

12. What Is the Success Rate of Surgical Treatments for Entropion?

Surgery for entropion often has a good success rate. The position of the eyelid significantly improves for the majority of patients, relieving discomfort and averting subsequent issues. The surgical approach employed, the surgeon's experience, and the underlying etiology of the entropion can all have an impact on the success rate. A trained eye professional consultation can provide more detailed information about the unique situation.

13. Does Entropion Surgery Involve Significant Pain?

In most cases, local anesthesia is used during entropion surgery to numb the afflicted region, although patients may still feel some discomfort afterward. With the help of prescription painkillers, the discomfort is often bearable, and it tends to lessen as the healing process advances. Although the degree of pain felt might vary from person to person, most individuals find the discomfort acceptable.

14. What Is the Typical Cost Associated with Entropion Surgery?

The cost of entropion surgery can vary significantly based on a number of variables, including the surgical center's location, the surgeon's level of experience, and the precise surgical methods used. For a specific cost estimate, it is important to speak with an ophthalmologist or eye surgeon. Regarding medically essential entropion surgery, insurance coverage could be a factor in some cases.

15. What Advantages Can Be Expected from Undergoing Entropion Surgery?

Numerous benefits of entropion surgery include pain relief and protection against corneal damage. Eliminating the inward bend of the eyelid reduces discomfort all the time as well as the chance of corneal abrasions, ulcers, and scarring. This not only increases visual clarity but also eye comfort in general. Additionally, patients frequently notice an improvement in their looks, which increases confidence. Ultimately, entropion surgery improves quality of life by removing tears, redness, and light sensitivity. This long-term remedy enables people to get back to their regular routines without the persistent discomfort and difficulty brought on by entropion.

Sources

Dr. Asha Juliet Barboza

Ophthalmology (Eye Care)

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