Entropion and ectropion correction

The eyelid protects the eye, distributes the tear film, and normally rests closely against the eyeball. Abnormal eyelid position can damage the ocular surface and interfere with tear drainage.

How do entropion and ectropion differ?

In entropion, the eyelid margin turns inward. The eyelashes rub against the conjunctiva and cornea, causing a foreign body sensation, tearing, redness, and erosions. Prolonged contact can cause more serious corneal damage.

In ectropion, the eyelid margin turns outward. The conjunctiva remains exposed, and the lacrimal punctum may lose contact with the tear lake.

Tearing and dryness can therefore occur together: tears are produced but are not distributed or drained properly.

What causes eyelid malposition?

• Age-related changes: tissue weakening and horizontal eyelid laxity.
• Scarring: following trauma, burns, inflammation, or surgery.
• Facial nerve paralysis: may cause ectropion and incomplete eyelid closure.
• Muscle spasm: may contribute to entropion.
• Mechanical effects: tumors and other space-occupying changes may deform the eyelid.

What is assessed before treatment?

The clinician checks eyelid margin and eyelash position, horizontal and vertical stability, orbicularis muscle function, punctal position, and completeness of eyelid closure.

Slit-lamp examination assesses the anterior segment and ocular surface, including corneal epithelial damage. Visual acuity testing measures the level of vision.

Surgery is planned to correct the specific anatomical mechanism causing the deformity.

Protecting the cornea before surgery

Lubricants, a protective contact lens, temporary eyelid taping, or other measures may be prescribed when needed.

These can relieve irritation and protect the cornea but do not always resolve the anatomical cause. If the eyelashes continue to rub against the cornea or the eye remains open, the clinician assesses the need for surgical correction.

How is the surgical technique selected?

The choice depends on the cause, tissue condition, punctal position, horizontal and vertical eyelid laxity, and corneal condition.

Treatment may involve eyelid tightening and shortening, retractor repair, canthal correction, or tissue reconstruction.

• Age-related lower eyelid entropion: horizontal laxity, spasm, retractor dysfunction, and corneal damage are assessed.
• Age-related ectropion with tearing: punctal position, eyelid laxity, dryness, and ocular surface exposure are evaluated. Reconstructive correction is performed when indicated.
• After trauma, burns, or surgery: scar traction and skin or mucosal deficiency are assessed. Scar release and tissue replacement may be needed.
• With facial nerve paralysis: prompt corneal protection and coordinated planning of functional correction are required.
• In a child with a congenital deformity: eyelash contact with the cornea, vision, and associated anomalies are assessed by a pediatric ophthalmologist and an appropriate ophthalmic surgeon.
• After recurrence following surgery: the clinician identifies persistent instability, scarring, and tissue deficiency. Repeat reconstruction is planned individually.

How do individual procedures differ?

Upper eyelid reconstructive surgery is performed for specific indications established during examination.

Trichiasis treatment without eyelid reconstruction does not replace entropion correction when eyelash contact is caused by abnormal eyelid position.

Postoperative monitoring and outcome assessment

The clinician monitors eyelid position, closure, sutures, and corneal condition. Follow-up timing and restrictions are determined individually.

The outcome is assessed by proper eyelid apposition, complete closure, absence of eyelash contact with the cornea, and normal punctal position.

Contact the clinician without waiting for a scheduled visit if increasing pain, a sudden reduction in vision, marked redness, or purulent discharge occurs after surgery.