EYELID MALPOSITION - ENTROPION

GENERAL CONSIDERATIONS

Entropion is a condition in which an eyelid (usually the lower lid) and lashes turn inward, rubbing against the eye, making it red, irritated, and sensitive to light and wind. If it is not treated, the condition can lead to excessive tearing, crusting of the eyelid, mucous discharge, and irritation of the eye. A serious inflammation could result in damage to the eye. Entropion can be diagnosed with a routine eye exam. Special tests are usually not necessary.

The condition occurs primarily as a result of advancing age with the consequent weakening of certain eyelid muscles. Laxity of the eyelid tendons, comined with weakening of these muscles results in the eyelid turning in. Entropion may also occur as a result of trauma, scarring, or other surgeries. There are two basic types of entropion - involutional and cicatricial. Involutional entropion is an age related change resulting from laxity of several eyelid structures. Cicatricial entropion is a scar-induced change that internally rotates the lid. Cicatricial entropion is frequently seen in ocular pemphigoid, an auto-immune condition with severe corneal changes and dry eye (sicca).

Symptoms result from direct contact between the eyelid margin and lashes with the eye, particularly the highly-sensitive cornea (the clear part of the eye that allows light to enter the eye). You may have a feeling that something is in the eye (foreign body sensation), ocular irritation, or there may be excessive tearing, crusting of the eyelid, or mucous discharge.

A chronically in-turned eyelid can result in acute sensitivity to light and wind, and may lead to eye infections, corneal abrasioins, or corneal ulcers. If entropion is present, it is important that it be surgically corrected before permanent damage to the cornea develops.

SURGICAL TREATMENT

Definitive correction of entropion rests with surgery. Prior to surgery, the eye can be protected by taping the lower lid down and using lubricating ointment (Lacrilube). The surgery for entropion relates to eyelid rotation whereby the in-turned lid is rotated outward. The surgery is performed under local anesthesia with intravenous sedation on an outpatient basis.

AFTER SURGERY

Pain is negligible after surgery - with most patients much more comfortable after surgery than before because of the immediate relief from the symptoms of entropion. No patch is required after surgery and patients simply use antibiotic ointment at bedtime for 7 - 10 days. Sutures are removed at 10 days in the office. .

RISKS AND COMPLICATIONS

Minor bruising or swelling may be expected and will likely go away in one to two weeks. Bleeding and infection, which are potential risks with any surgery, are very uncommon.

CONCLUSIONS

Dr. Kohn has performed several thousand entropion repairs with a 99% success rate. Most patients experience immeiate resolution of the problem once surgery is completed with little, if any, postoperative discomfort. After your eyelids heal, your eye will feel comfortable and you will no longer have the the risk of corneal scarring, infection, and loss of vision from corneal ulceration and scarring.