Entropion: eyelid turning inwards, causes, symptoms and surgery

Cambridge University Hospitals says that as a temporary solution your eyelid skin can be taped to your cheek to keep the lashes away from the surface of the eye, and lubricant drops or ointment help relieve discomfort. However, surgery is needed for a definitive solution, and its aim is to restore the eyelid to its normal position, protect the surface of the eye from damage and improve comfort. East Kent Hospitals adds that temporary relief can also be achieved by an injection to weaken the muscle that causes the lid to turn in.

Your options are discussed with your surgeon before any decisions are made. If entropion is left alone, the in-turning lashes can scratch the eye surface significantly, so it is worth being assessed rather than waiting.

The NHS lists entropion alongside ectropion as a cause of an eyelid turning inwards or outwards. In entropion, the eyelid margin turns in and the eyelashes rub against the eye. Cambridge University Hospitals focuses on the lower eyelid, which is the one usually affected.

Cambridge University Hospitals says the in-turning eyelid usually causes the following. East Kent Hospitals describes the eye as feeling sore.

• Irritation and discomfort in the eye.

• Redness.

• Excess tearing (a watery eye).

• Mucus discharge.

• A scratch on the surface of the eye if the lashes keep rubbing and the problem is untreated.

Most cases are due to the eyelid tissues becoming loose with ageing, according to Cambridge University Hospitals. East Kent Hospitals describes this as the eyelid muscle going into spasm and turning inwards in old age. Rarely, the problem is present from birth (congenital).

It can also follow scarring of the inner lining of the eyelid, caused by certain skin conditions, infection, chemical or thermal burns, or other eyelid trauma, or injury or disease of the eyelid.

East Kent Hospitals says entropion is usually diagnosed by a routine eye examination with an optician or ophthalmologist, and special tests are not usually needed. The NHS says to see a GP, optician or pharmacist about an eyelid problem and not to self-diagnose.

Cambridge University Hospitals describes surgery as usually performed under local anaesthetic as a day case. In most cases the eyelid is tightened and rotated into its normal position with some fine stitches. Rarely, the inner lining of the eyelid needs to be enhanced with a graft. The local anaesthetic injection is a little uncomfortable but the operation is not painful and generally lasts about 30 to 45 minutes. East Kent Hospitals gives the surgery as usually 45 to 60 minutes, with a stay of 3 to 4 hours in the hospital in total.

Medicines matter. Cambridge says bruising can be greater with blood-thinning tablets such as aspirin, clopidogrel or warfarin, which may need to be stopped only if the surgeon advises, and that it can complete surgery safely without stopping them if required. East Kent asks anyone taking anticoagulants to tell the team before surgery and to arrange for someone to take them home, because the eye drops blur vision.

Cambridge University Hospitals says a pressure dressing may be applied to reduce swelling and bruising, though often it is not necessary. Ice packs applied intermittently for the first 48 hours help to stop swelling. The dressing is usually removed at home the day after surgery. You can clean the wound carefully with cooled boiled water and cotton wool pads, shower normally and pat the wound dry. Antibiotic drops or ointment may be prescribed for about a fortnight.

You can return to work or normal activities within a few days, though it is best to avoid swimming for a fortnight. The eye may feel gritty and tender at the outer corner while it heals. Stitches are usually self-dissolving; if they need removing you are seen around 3 weeks after the operation. Otherwise review is at around 3 months to check the lid position. East Kent Hospitals says you can usually return to work the day after the procedure and should not drive until your vision has cleared, preferably not until the next day.

Cambridge University Hospitals and East Kent Hospitals both list the following.

• Swelling and bruising of the eyelid, usually settling in 10 to 14 days (Cambridge) or 1 to 2 weeks (East Kent).

• Infection of the eyelid or eye socket, which is rare.

• Entropion coming back, or the eyelid turning too far outwards (overcorrection), needing further surgery.

• A scar that usually blends into the natural skin crease and is barely visible in most cases, but may be noticeable.

• Rarely, a tender lump called a granuloma in the wound, which usually settles but may need removing.

• Allergic reaction to the anaesthetic or drops, which is rare.

• A very rare risk of loss of vision, stated by Cambridge as occurring in less than 1 in 20,000 cases of eyelid surgery.

The NHS lists several eyelid problems with different causes. Entropion and ectropion are opposites, and both are more common in older people.

The NHS says to see a GP if you are worried about an eyelid problem or symptoms are not improving or are lasting a long time. Ask for an urgent GP or optician appointment, or get help from NHS 111, if your eyelid is red, hot, painful, tender or blistered; the pain is in your eye rather than the eyelid; the white of the eye is very red; you are sensitive to light; your eyesight changes; or you have eye symptoms with a headache and feeling or being sick.

After surgery, contact the eye department or the urgent eye service number on your discharge leaflet if your eye is bothering you, and use NHS 111 or A&E for severe pain, loss of vision or bleeding.

On the NHS, entropion is usually spotted by an optician or GP and referred to an eye department, where oculoplastic or ophthalmology teams perform the surgery as a day case. Waiting times vary by area.

Private eyelid surgery is also available, usually for speed. The operation and the risks described above are the same in either setting. Ask who will follow you up if the lid position is not right, and how to reach them out of hours.