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Health condition · Clinically reviewed

Entropion, the inward-turning eyelid - and the small operation that fixes it.

A gritty, watery, chronically irritable eye caused by lashes rubbing against the cornea. Treatable, and best treated before it scars.

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Why trust this guide

  • 01

    Clinically reviewed

    Written by our editorial team and reviewed by a registered UK clinician before publication.

  • 02

    Sourced from guidance

    Checked against Royal College of Ophthalmologists, NICE and peer-reviewed oculoplastic sources.

  • 03

    Current for 2026

    Reflects modern UK practice on temporising sutures, lateral tarsal strip and cicatricial repair.

Key facts

Entropion at a glance.

The essentials, in plain English - what it is, the types, and how it is treated in the UK today.

  • What it is

    Inward turning of the eyelid margin so eyelashes and skin rub against the cornea and conjunctiva.

  • Which lid

    Usually the lower lid, and usually one eye at a time - though both can be involved.

  • Main type

    Involutional (age-related) is by far the most common in the UK - horizontal lid laxity and retractor disinsertion.

  • Cicatricial type

    Scarring of the tarsal conjunctiva - trachoma worldwide, and Stevens-Johnson syndrome, pemphigoid or radiotherapy in the UK.

  • Why it matters

    Persistent corneal abrasion can cause ulceration, infection and, if neglected, permanent visual loss.

  • Fix

    Lubrication and a bandage lens for comfort - definitive relief is oculoplastic surgery matched to the cause.

Why this guide matters

A treatable problem, if you catch it early.

Entropion is common in older adults and it damages the cornea day after day. The three points below shape everything else on this page.

  • Type drives the operation

    Involutional, cicatricial, spastic and congenital entropion each need a different surgical approach - the diagnosis matters as much as the treatment.

  • Sutures buy time, surgery cures

    Quickert sutures and tape give days to weeks of relief - a tarsal strip and retractor advancement fixes the underlying anatomy.

  • Cicatricial disease needs a partner

    When scarring drives the entropion, the surgeon works alongside immunology, dermatology or ocular surface specialists - or the recurrence rate stays high.

How the diagnosis is made

From gritty eye to a clear plan.

The steps a UK GP, optometrist or ophthalmologist will normally follow, in order - so you know what to expect and why.

  1. 01

    Assessing

    History and eye symptoms

    Grittiness, watering, photophobia and a red irritable eye - and any history of trachoma, chemical injury, surgery or Stevens-Johnson syndrome.

  2. 02

    Assessing

    Lid position and lash contact

    Direct inspection of the lid margin - inward rotation, lashes touching the globe and any provocation on forced blink or Valsalva.

  3. 03

    Assessing

    Snap-back and distraction

    Simple bedside tests for horizontal lid laxity - the mainstay signal of involutional entropion.

  4. 04

    Confirming

    Fluorescein staining

    Highlights corneal abrasion, punctate keratopathy or frank ulceration from the abrading lashes.

  5. 05

    Confirming

    Slit-lamp and visual acuity

    Assesses tarsal conjunctival scarring, subtarsal fibrosis and any impact on vision.

  6. 06

    Confirming

    Trichiasis assessment

    Misdirected lashes without lid malposition is a distinct entity - it often coexists and changes the treatment plan.

  7. 07

    Preparing

    Oculoplastic referral

    For temporising sutures, definitive lid surgery or mucous membrane grafting in cicatricial disease.

Typical timeline: a first visit to a settled plan in weeks, not months.

Symptoms

What entropion actually feels like.

The classic mix of grittiness, watering and photophobia - and the features that mean it is time to be seen urgently.

  • Foreign body sensation

    The commonest symptom - a persistent gritty feeling from lashes abrading the cornea.

  • Watering and reflex tearing

    Constant tearing as the eye tries to protect itself from mechanical irritation.

  • Photophobia

    Light sensitivity from corneal surface disturbance and inflammation.

  • Redness and irritation

    Conjunctival injection and a chronically inflamed eye that never quite settles.

  • Corneal abrasion or ulcer

    The critical complication - abrasion, ulceration and, if infected, sight-threatening keratitis.

  • Inward-turned lid margin

    Visible on inspection - sometimes only revealed with forced blink or gentle globe pressure.

  • Intermittent presentation

    Early involutional entropion can come and go - normal one moment, rolled inward the next.

  • Red flag - vision loss or ulceration

    Any drop in vision, white spot on the cornea or severe pain needs same-day ophthalmology.

Treatment

How entropion is treated in the UK.

Lubrication and a bandage lens for comfort, everting sutures for quick relief - and definitive oculoplastic surgery matched to the cause.

  • Lubrication

    Preservative-free artificial tears through the day and lubricating ointment at night to protect the ocular surface while awaiting definitive care.

  • Bandage contact lens

    A soft bandage lens for short-term corneal protection while surgery is being arranged - fitted by a specialist.

  • Quickert everting sutures

    Temporary transverse sutures that rotate the lid margin outward - fast relief while a definitive repair is planned.

  • Adhesive taping

    A simple external tape to hold the lower lid down and stop lash contact - useful as a very short-term measure.

  • Lateral tarsal strip

    The workhorse for involutional entropion - tightens the horizontal lid and repositions the margin.

  • Retractor advancement (Jones)

    Reattaches the disinserted lower lid retractors, correcting the vertical component of involutional entropion. Often combined with a tarsal strip.

  • Tarsal fracture / rotation

    Wies, Trabut or transverse tarsotomy procedures rotate a scarred tarsus outward - the mainstay for cicatricial entropion.

  • Mucous membrane graft

    Buccal mucosa or amniotic membrane replaces scarred conjunctiva in severe cicatricial disease such as pemphigoid or Stevens-Johnson.

  • Botulinum toxin

    Chemodenervation of the orbicularis calms spastic entropion in the short term. See our guide to medical and neurological Botox.

  • Congenital repair (Hotz)

    A specialist paediatric procedure for the rare congenital form - excises a strip of skin and orbicularis to restore lid position.

  • Treat the underlying disease

    Immunosuppression for pemphigoid, control of Stevens-Johnson sequelae and long-term care of chronic inflammation - see our page on Stevens-Johnson syndrome.

  • Trichiasis management

    Epilation, electrolysis or cryotherapy for misdirected lashes that persist or coexist - a separate but overlapping problem.

What this guide is based on

The sources behind every claim on this page.

UK national guidance and specialist society standards, current at the time of last review.

Key references

Guidelines and standards we relied on.

A quiet reminder

This guide is for information, not medical advice.

Your GP or ophthalmologist knows your eye and history and can tell you which parts apply to you. If in doubt, get seen.

  • Royal College of Ophthalmologists. Commissioning guidance: adult oculoplastic services.

  • NICE Clinical Knowledge Summary. Red eye.

  • BMJ Best Practice. Entropion.

  • American Academy of Ophthalmology. Basic and Clinical Science Course - Orbit, Eyelids and Lacrimal System.

Red flags

When entropion needs urgent attention.

Most entropion is a routine oculoplastic referral. These are the situations where it is not - and where a same-day opinion is needed.

  • Sudden drop in vision

    Any acute reduction in acuity in an eye with entropion needs same-day ophthalmology - suspect corneal ulceration or infection.

  • White spot on the cornea

    A visible white lesion suggests an infected ulcer - urgent slit-lamp assessment and treatment.

  • Severe pain and photophobia

    Pain out of proportion to a routine gritty eye deserves same-day review, not a week of waiting.

  • Post-Stevens-Johnson eye disease

    Ongoing conjunctival scarring after Stevens-Johnson syndrome or toxic epidermal necrolysis needs specialist ocular surface care - not just lubricants.

  • Mucous membrane pemphigoid

    Progressive cicatricial entropion in a patient with dry mouth and oral or genital blistering needs immunology-led immunosuppression.

  • Post-radiotherapy scarring

    Cicatricial entropion after periocular radiotherapy is a specialist reconstruction case - not a simple tarsal strip.

  • Chemical or thermal burns

    Acute burn injuries can cause rapid cicatricial change - early amniotic membrane and specialist input change the outcome.

  • Recurrent entropion after surgery

    A second recurrence is a signal that the diagnosis or plane of repair is wrong - re-refer for oculoplastic reassessment.

  • Congenital entropion in an infant

    Rare but real - persistent lash-cornea contact in a baby is an urgent paediatric ophthalmology referral.

Living with it

A treatable condition, with a clear ladder.

Four things that make the biggest difference while you wait for surgery, and for the weeks after - lubrication, gentle taping, watching for red flags and committing to definitive repair.

A quiet reminder

Comfort now, cure soon.

Lubricants and tape are for the days between now and the operation - not a lifetime strategy.

  1. 01 Comfort

    Lubricate generously

    Preservative-free artificial tears through the day and lubricating ointment overnight - the single most useful thing while you wait for surgery.

  2. 02 Protect

    Tape if you need to

    A small piece of hypoallergenic tape pulling the lower lid gently downward can buy hours of comfort in a flare.

  3. 03 Watch

    Know the red flags

    A sudden drop in vision, a white spot on the cornea or severe pain means same-day eye casualty - not next week.

  4. 04 Fix it

    Definitive surgery works

    For involutional entropion a tarsal strip and retractor advancement has a high success rate under local anaesthetic in day surgery.

Frequently asked

Everything we get asked about entropion.

Quick answers on sutures, tarsal strips, Botox and what recovery looks like.

  • What is entropion?

    Entropion is inward turning of the eyelid margin so that the eyelashes and skin abrade the cornea and conjunctiva. It is most often age-related and affects the lower lid, and it causes a persistent gritty, watery, red and light-sensitive eye that can eventually damage the cornea if untreated.

  • Is entropion an emergency?

    The lid position itself is not an emergency, but the complications can be. A sudden drop in vision, severe pain or a white spot on the cornea suggests an infected ulcer and needs same-day ophthalmology. Everything else can usually wait for a routine oculoplastic clinic - kept comfortable with lubrication in the meantime.

  • How is entropion different from ectropion?

    Ectropion is outward turning of the lid margin - the lid falls away from the eye - and it causes exposure, dryness and a watery eye. Entropion is inward turning, so the lashes rub. Both are common in older adults and both are corrected surgically, but the operations are different.

  • What is the definitive treatment?

    For age-related involutional entropion it is a short day-case operation combining horizontal lid tightening (lateral tarsal strip) and reattachment of the lower lid retractors. For cicatricial entropion from scarring diseases the repair is more complex and often involves rotating the tarsal plate or grafting new mucous membrane.

  • How successful is entropion surgery?

    For involutional entropion, published series report success rates well above 90 per cent with a lateral tarsal strip and retractor advancement. Cicatricial entropion has a higher recurrence rate because the underlying disease keeps scarring - which is why treating the underlying condition matters as much as the operation.

  • Can Botox help?

    Yes, for the spastic form driven by orbicularis muscle over-activity. Botulinum toxin injected into the pretarsal orbicularis can rotate the lid outward for several months. It is a bridging treatment, not a substitute for definitive surgery when the underlying problem is anatomical laxity or tarsal scarring.

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