Entropion surgery (eyelid turned inward)

We speak of entropion when the eyelid - usually the lower eyelid is affected - is turned inwards. This can have serious consequences because the eyelashes rest on the cornea and chafe. Surgical correction is therefore unavoidable in the vast majority of cases.

In our eye practice, we usually perform the entropion operation on an outpatient basis under local anaesthesia. An in-patient stay is not necessary. The prognosis after entropion surgery is usually very good. We are usually able to normalise the position of the eyelid or at least improve it considerably.

What is an entropion?

Entropion - also called rolled eyelid - is a malposition of the eyelid that almost always affects the lower eyelid. Due to an inward rotation of the eyelid, the eyelashes rest on the cornea where they permanently rub and can leave permanent damage in the long term. An inwardly rotated eyelid can be congenital or occur in the course of life. The most common cause is age-related slackening of the connective tissue. The slackening of the tissue causes the eyelid to roll inwards, causing persistent irritation. An entropion does not regress on its own. Therefore, entropion surgery is usually essential to prevent further damage to the eye.

What can cause an entropion?

The most important cause of an inwardly turned eyelid is advanced age. Due to the loss of elasticity of the skin and the underlying structures, the position of the eyelid can change. The lower eyelid is no longer held firmly in place and rolls inwards.

Scarring in the eyelid region can also exert traction on the eyelid. If the scars are on the outside, the result is often a so-called ectropion, an eyelid that is turned outwards. Scarring on the inside of the eyelid pulls the edge of the eyelid inwards so that an entropion occurs. Possible causes are, for example, eye injuries, strong allergic reactions or a more severe conjunctivitis.

A special form is the so-called spastic entropion. In this case, the turned-in eyelid is caused by eyelid spasms. The muscle contractions cause the eyelids to roll in during the spasm. Spastic entropion usually occurs spontaneously and subsides after the spasm. Surgery can also be helpful in this case. In addition, there are medicinal treatment options.

Last but not least, there are also people who have congenital entropion. Entropion often appears in infancy and disappears during the growth phase without further complications. If this does not happen, entropion surgery may become necessary at a later stage.

What complaints can entropion cause?

An eyelid that is turned inwards causes constant irritation of the cornea. Due to the permanent rubbing of the eyelashes, those affected suffer from a chronic foreign body sensation. The eyes are usually permanently red, painful, sensitive to light and watery. Because of this discomfort, sufferers often feel a strong urge to squint their eyes, which in turn makes the discomfort worse. A vicious circle develops, which often ends in chronic conjunctivitis. If left untreated, entropion can leave permanent damage to the cornea. Since the cornea is responsible for the refraction of light in the eye, vision can be impaired over time. In the worst case, blindness may even result if the rolled-up eyelid causes adhesions, inflammation or ulcers on the cornea.

How can entropion be treated?

In most cases, entropion can be treated well with surgery. The prerequisite for a successful entropion operation is that the rolled-up eyelid is corrected as early as possible. If there are already permanent changes to the cornea, these may have to be corrected in a separate operation.

Accompanying the entropion operation, the treating ophthalmologist can administer medication, for example if conjunctivitis has already occurred.

A purely conservative therapy is usually not successful. It is possible to temporarily protect the eye with contact lenses or to lift the lower lid from the eye with a plaster bandage. However, permanent relief is not possible with these methods because the malposition of the eyelids is not corrected. 

When is entropion surgery necessary?

Entropion surgery is almost always unavoidable for rolled eyelids. An entropion does not regress spontaneously. An exception is congenital entropion, which occurs in infancy when the eyelash structures are still very soft and do not cause irritation.

In this case, the eyelid position usually normalises during growth. In all other cases, entropion should be corrected surgically. Even with more pronounced malpositions, we usually achieve good results with an entropion operation. 

What is the procedure of an entropion operation?

We usually perform entropion surgery on an outpatient basis under local anaesthesia with sedation. The anaesthetist is on site throughout the operation to check your vital signs and make sure you are well. The procedure usually takes no longer than 30 minutes. The operation is preceded by a thorough ophthalmological examination. You will also be fully informed about the exact course of treatment, aftercare and possible risks.

During entropion surgery, the position of the eyelid is corrected using various surgical techniques. The exact procedure depends on what has caused the entropion and what keeps the eyelid in its curled position. Often the edge of the lower lid is tightened and so-called traction sutures are placed to turn the lower lid outwards.

After the operation, the eye is covered with a bandage for about 24 h and treated with a special eye ointment. We remove the stitches about 10 to 14 days after the entropion operation. By this time, the initial swelling and discolouration should have largely disappeared. The treating ophthalmologist will carry out another careful check-up and, if necessary, plan the next steps of treatment together with you.

What should I bear in mind after entropion surgery?

Physical rest is particularly important after entropion surgery. You should allow yourself plenty of rest and carefully cool the eye area to counteract initial swelling and bruising. 

We recommend that you sleep on your back with your upper body slightly elevated for the first few days. You should refrain from visiting the sauna, solarium and swimming pool for 2 weeks. You should also be careful with direct sunlight. UV radiation can cause the fine scars to discolour unattractively, which is why we advise consistent sun protection during the first 6 months. You can carefully resume sporting activities after about a week in consultation with your doctor.

Are there any risks associated with entropion surgery?

Like any operation, entropion surgery always involves a certain risk. However, the procedure is usually uncomplicated. In individual cases, complications such as post-operative bleeding, wound healing problems or infections can occur. To avoid the latter, you should avoid touching the eye area with your fingers after the operation. In very rare cases, an overcorrection occurs during the entropion operation, so that the edge of the eyelid now turns outwards. This so-called post-operative ectropion can disappear on its own after a few months. If this does not happen, a corrective operation may be necessary. 

An optimal eyelid position is not always achieved by entropion surgery. This is especially true in cases where the entropion has been present for a very long time. Therefore, it is always advisable to have inwardly turned eyelids treated as early as possible. 

Can an inwardly turned eyelid come back?

Occasionally, after an entropion operation, a recurrence of the eyelid malposition occurs. In this case, a second corrective operation is necessary. The earlier the entropion is treated, the greater the chances of a successful and permanent correction.