Entropion

IN-TURNING EYELID (ENTROPION)

Entropion is inward turning of the eyelid. It causes the lashes and lid skin to rub the surface of the eye. This causes discomfort, watering and redness of the eye. If untreated it can lead to ulceration of the surface of the eye, especially the cornea, followed by scarring which could cause loss of vision.

What are the causes of entropion?

Lower lid entropion is usually due to aging changes in the eyelid making it lax and prone to flip inwards. Often at the start entropion is intermittent but it often becomes constant later on.

What is the treatment for entropion?

Entropion is treated by lid surgery, which is generally done under local anaesthetic as a day case.

Temporary measures until surgery takes place include:

• Taping the lid skin to prevent the lid turning in. The doctor or nurse can show you how to do this.

• If your eye is sticky or infected, antibiotic drops will keep this under control until the operation can be carried out.

• Botulinum toxin injections to weaken the muscles that are pushing the lid inwards.

• Everting sutures - Stitches are placed in the lid to stiffen it and stop it turning in. This is a quick operation, which can be carried out on both lower lids at the same visit. The effect is temporary however.

What types of operation are there for lower lid entropion?

There are several surgical techniques for entropion.  One common procedure is to perform a lateral tarsal strip procedure together with placing deep stiches to tighten the muscle that opens the lid (the lid retractors).   Lateral tarsal strip is an operation to tighten the lid horizontally. The lid is tightened at the outer corner by stitching the outer part of the lid to the tissue covering the bone of the eye socket. A deep stitch is used in this operation, which is permanent. All the surface stitches are absorbable and will dissolve and can be removed by your eye specialist in 7-10 days after the operation. Occasionally the deep stitch will come loose and then the operation may need to be redone.

 It takes about 45 minutes to perform.

What happens after the operation?

You will have an eye patch over the side of your eye after the operation.  Leave any eye pad on for at least 4 hours - this will help to reduce bruising.

Do not worry if there is some blood on the eye pad when you remove it. Clean the eyelids gently with cooled, boiled water or (saline from the chemist) and cotton wool or tissues. It is normal for the eyelids to appear swollen and bruised for the first week or so.

If your eyelid feels sore when the anaesthetic wears off, take painkillers like Paracetamol or Ibuprofen. You may apply ice pack or frozen peas over the area of surgery to reduce pain and swelling.

The discomfort usually settles within one or two days. Use the ointment in the eye and on the stitches as instructed. If you have severe pain, not relieved by simple painkillers, please ring our eye clinic for advice or if afterhours or during public holidays you may contact Royal Victorian Eye and Ear Hospital on (03) 9929 8666.

The surgeon will normally use dissolving stitches in your eyelid, they often fall out on their own within 2 weeks, otherwise your surgeon will remove them for you after 14 days.

What are the risks of entropion surgery?

• Discomfort and bruising in the lids

• Occasionally the stitches irritate the eye and if necessary they could be removed in clinic.

• Infection of the eyelids. This is not common 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.

• Recurrence of the entropion after months or years. This may be because the aging changes in your eyelid have continued. If it does occur your eye specialist may arrange a further operation to treat the entropion.

• Eyelid scarring

• Rarely, the lid starts to turn outwards after the operation. Removing the stitches early may help this settle, but if they have already disappeared another operation may be needed to correct the position of the lid.