A Family Doctor's Tale - ENTROPION

DOC I HAVE ENTROPION

Recently I have a elderly female patient who complained of pain in her left eye due to pricking sensation in conjunctiva(the white part of the eye). What has happened is that the eyelashes on the lower eyelid has become pointed inwards towards the eye. It is usually due to the inversion of the lower eyelid which cause the eyelashes to point inwards and cause pain or irritation of the eye.
My own mother also suffered from this condition about 20 years ago. Many times she had her lower eyelashes removed by laser. She also had operation to tighten the lower eyelid muscle to evert the lower eyelids. Regrowth of the eyelashes is fairly common. Tightening of the eyelid muscle last longer before the muscle become loose again.


Entropion ( A Simple Guide to Entropion) is an inversion(rolling inwards) of the eyelid usually in a elderly person.


Entropion is more common in women than in men.


The causes of Entropion can divided into 2 type:


Spasm of Orbicularis muscle:

1. Degeneration of the peripheral connective tissue of the eye


2. Occurs in old age


3. Occurs also after removal of eyeball


4. Primarily affects the lower eyelid.


Cicatricial:

1. Scarring  of the eyelid muscle to connective tissue as a result of injury,  trauma, burns


2.retraction of the connective tissue of eyelid from infections such as trachoma, chronic infections


3.Congenital disease


4. May affect either upper or lower eyelid


Symptoms varies from mild to severe due to rubbing of eyelashes against the cornea or conjunctiva:

1.Irritation of the conjunctiva


2.Conjunctival congestion - increased blood flow through irritated eye shows up the blood vessels


3.Tearing -excess tears from irritation


Signs:

1.Erosions, opacities and vasculisation of the cornea


2.increased dilated blood vessels of conjunctiva present due to irritation


3.The presence of inward turning eyelids and eyelashes


The presence of inward direction of the eyelashes and eyelid can be seen more accurately using a slit lamp microscope.

Some of the complications from entropion are:
1.Recurrent corneal ulcers


2.Recurent irritation and conjunctivitis of eyes.


3.Severe infection of the eye - rare


Treatment depends on the type of Entropion:


1.Conservative - Eversion of eyelid especially lower eyelid with adhesive plaster or tape for temporary relief together with lubricating eyedrops


2.Surgery - 
a.Removal of inturning eyelashes using laser
        
b.Operation to tighten the eyelid muscle:

Quickert procedure: 2 to 3 strategically placed stitches are used under local anesthesia to evert the eyelid.
Recurrence is common.
This is useful for patients who are not suitable for surgery


Repair of inverted eyelid: is done by incision above and below the eyelids and removal of connective tissue or scarred tissue and tightening of the eyelid muscle.
This is usually done on an outpatient basis and under local anesthesia.

Post operatively the wounds are protected by antibiotic creams and dressings.
Healing usually occurs within 1 week.


Antibiotics are also given for any infections of the conjunctiva and cornea.


The prognosis is usually good.


Recurrence is rare but do occur especially due to weakening of eye muscles from age.