Entropion

Definition/diagnostic criteria Entropion is an ocular condition characterised by the inward turning (inversion) of the eyelid margin. This results in eyelashes and skin rubbing against the cornea and conjunctiva, leading to discomfort and potential ocular damage. The condition is typically classified into two main types: involutional (age-related) and cicatricial (due to scarring).

Epidemiology Entropion predominantly affects the elderly, with a higher incidence in those over 60 years of age. Involutional entropion is the most common type, linked to age-related changes in eyelid tissue. Cicatricial entropion, though less common, is associated with ocular scarring due to infections, trauma or autoimmune conditions.

Diagnosis
Clinical features: Patients usually present with symptoms of eye irritation, tearing and photophobia. On examination, the inward turning of the eyelid is evident. Complications such as corneal abrasion or infection may be present due to continual eyelash rubbing.

Investigations: Diagnosis is primarily clinical. In cases of cicatricial entropion, identifying the underlying cause is crucial.

Treatment Treatment options vary based on the type and severity of entropion.

• Non-surgical management: For temporary relief, taping the eyelid in an outward position or using lubricating eye drops and ointments can be effective. Botulinum toxin injections are another non-surgical option for temporary correction, particularly in patients unfit for surgery.
• Surgical management: Surgery is the definitive treatment for entropion. Techniques vary, but they generally aim to correct the eyelid malposition and address underlying causes, such as laxity or scarring. Involutional entropion may require procedures like lid tightening or retractor reinsertion, while cicatricial entropion may need scar revision and grafts.

Prognosis The prognosis for entropion is generally good, especially when treated promptly. Surgical outcomes are typically successful, with low recurrence rates. However, untreated entropion can lead to chronic irritation, infection, and potentially serious corneal damage.