Do you sometimes feel like there is something inside your eye, or your eyes are red and constantly watering? This is when the eyelid rolls inward and hits the inside of the eyeball. Today we are going to talk about this condition, which is known in medical science as 'Entropion'. Don't worry, once you are aware of this, you will realize that this is not such a big problem.
What is Entropion? Let's understand it simply!
Simply put, entropion is when your eyelid turns inward, toward your eyeball. When this happens, the skin of your eyelid and eyelashes rub against the surface of your eye. Imagine, it feels like a grain of sand in your eye. This friction can cause a lot of damage to the surface of your eye, especially the transparent part at the front of your eye, the cornea , and can even cause injury.
There is another side to this, which is when the eyeball turns outward. That is called 'Ectropion'. But today we are talking about turning inward.
Entropion often affects the lower eyelid . Some people may have it in only one eye, while others may have it in both eyes. We call it ``Bilateral entropion''. If this is not treated properly, as I said, the cornea may be damaged and even vision may be lost . Therefore, if you have these symptoms, it is very important to see an ophthalmologist for treatment. As a first step, non-invasive methods are tried, but sometimes surgery may be necessary.
What are the main types of entropion?
There are several main types of entropion. Let's take a look at what they are:
- Involutional entropion: This is the most common type . As we age, the muscles and tendons around our eyes gradually weaken and loosen. That is the main reason for this. Just as our grandparents' skin wrinkled, the strength of the things inside also decreases.
- Spastic entropion: This type can occur if the eye is disturbed in any way, for example, by rubbing the eye too hard, if the eye becomes infected, or if the eye becomes swollen. It is especially likely to occur after eye surgery , or in people who already have a loose eyelid due to aging.
- Cicatricial entropion: This is a condition in which scar tissue forms on the eyelid. This can be caused by a burn, a severe infection, an eye injury, eye surgery, or radiation therapy for cancer. This scarring causes the eyelid to turn inward.
- Congenital entropion: This is very rare, but some babies are born with this condition. This means that the eyeball is turned inward from birth .
- Mechanical entropion: This occurs when the eyeball becomes too heavy, causing it to roll inward. This can happen if a mass or tumor develops in the eyeball.
What are the symptoms of entropion?
If you have entropion, you may experience several uncomfortable eye symptoms. See if these sound familiar to you:
- A constant feeling like there's something in the eye. Like a speck of dust or an eyelash stuck in it.
- Redness of the eyes.
- Frequent tearing (watery eyes).
- Blurred vision.
- Eye pain.
- Itchy eyes.
- Sensitivity to light (difficulty looking outside in bright light - we call this ``Photophobia'') and sensitivity to wind.
- A watery discharge from the eyes or watery discharge from the corners of the eyes.
When you first develop entropion, you may only experience these symptoms occasionally. However, over time, these symptoms usually become more persistent.
Why does entropion occur? What are the causes?
There are three main features of an eyelid with entropion: eyelid laxity, the eyelid retractor muscle that lifts the eyelid out of its place of attachment, and the eyelid closing muscle that is too strong, turning the eyelid inward instead of outward. Lower eyelid laxity is very common in people over 60 years of age , because the support for the eyelid weakens with age.
In addition, there are several other reasons why the eyelid may turn inward:
- Eye injuries.
- Eye infections.
- Previous eye surgeries.
- Swelling and inflammatory conditions of the eyes.
- Scar tissue caused by any of the aforementioned causes.
Who is at higher risk of developing entropion?
Age is the biggest risk factor for developing entropion. It most commonly occurs in people over the age of 60. According to the American Academy of Ophthalmology, the condition affects about 2.1% of people over the age of 60.
Also, people with sleep apnea are at higher risk of developing entropion. This is because their upper eyelids may be too loose (called "Floppy eyelid syndrome"), which makes them more likely to roll inward.
Another thing is that it has been found that women are more likely to develop entropion than men.
How do doctors diagnose entropion?
Your eye specialist will first ask you about your symptoms and medical history. Then he or she will perform a complete eye exam . He or she will check for any skin problems, infections, or scarring. He or she will also examine the edges of the eyelids carefully, as there are other conditions that can look like entropion. It is important to make an accurate diagnosis , as this will determine the best treatment.
Tests used to diagnose entropion
The doctor can perform several tests to confirm whether you have entropion:
- Snap-back test: In this test, the doctor pulls down your lower eyelid without letting you blink. Then they watch how long it takes for it to go back up. It usually goes back up within a second or two.
- Distraction test: In this test, the doctor pulls your lower eyelid away from your eyeball. By pulling it, the distance between the eyelid and the eyeball is measured. If this distance is more than 6 millimeters, it is considered abnormal.
- Slit lamp exam: A slit lamp is a special microscope . Using a bright light, the doctor will examine your eye carefully to see if there are any signs of this condition. This can detect even the smallest damage to the eye.
What are the treatments for entropion?
Your doctor may use several methods to treat entropion. Common treatments include:
- Lubricating eye drops: Applying an oily ointment or artificial tears to the eye can help reduce discomfort. However, this is not a long-term solution.
- Soft contact lenses: Your doctor may recommend using soft contact lenses to protect your eyes from eye problems. These lenses act like a bandage and reduce symptoms.
- Tape: A special type of tape can be used to temporarily hold the eyelid in place. This is also something that can be done easily at home.
- Stitches: The doctor may reposition the eyelid and place a few stitches to hold it in place. The scar tissue created by these stitches will help keep the eyelid from turning outward for several months.
- Botox® Injections: A small amount of a drug called Botulinum toxin can be injected into the muscles that turn the eyelid inward. This provides relief for several months.
- Eyelash removal / Epilation: To stop the annoying eyelashes from rubbing against the surface of the eye, the process of plucking and removing them is called ``Epilation''.
Remember, most of these treatments are temporary. If you want a permanent solution, you will need surgery.
Sometimes, if the inverted pupil is caused by chronic inflammation, your doctor may order blood tests (labs) or a biopsy to check for rare causes such as ocular cicatricial pemphigoid or trachoma.
Entropion surgery
Although the non-surgical treatments mentioned above can help in the short term, surgery is usually required to completely correct an inverted eyelid and return it to its normal position. This surgery is usually performed under sedation and local anesthesia. You will be able to go home the same day as your surgery.
There are several surgical procedures to correct entropion:
- Eyelid tightening: This involves tightening your eyelid by shortening it a little (called a wedge resection or lateral tarsal strip).
- Retractor reinsertion: This involves tightening the muscle that opens and closes the eyelid (the `lid retractor`).
- Orbicularis debulking: This involves weakening part of the muscle that helps close the eyelid (the orbicularis muscle).
- Eyelid margin reconstruction: Electrocautery or cryotherapy can be used to permanently remove an eyelid that has deviated due to injury or chronic inflammation.
Although non-surgical treatments are helpful in the short term, surgery is usually required to completely and permanently correct entropion.
Many people experience temporary side effects after entropion surgery. Swelling and bruising are the most common. These are a normal part of the healing process. These can be managed with medication prescribed by your doctor and cold compresses. In most cases, the surgery is completely over within two weeks.
When should I see a doctor?
If you feel like your eyeball is turning inward, seek medical advice immediately. If your eyeball doesn't seem to be turning inward, but you constantly feel like there's something inside your eye, see a doctor. It could be entropion.
What questions should you ask the doctor?
If you have entropion, you can ask your doctor these questions:
- What complications should I watch out for?
- What should I avoid during recovery?
- Do I need to come back for the tests? If so, when?
- What can I do to prevent entropion from recurring?
Can entropion be prevented?
Entropion is a condition that is often a natural part of aging and sometimes caused by scar tissue, so it is difficult to completely prevent it. However, to reduce the risk of developing entropion due to an eye injury, wear safety glasses when doing work that could injure your eyes (for example, when cutting wood or welding).
What happens if you have entropion? What can you expect?
Many people who seek treatment for entropion before it causes damage to the eye have good results. Entropion surgery usually resolves the problem, and the condition rarely recurs.
However, it is important to treat entropion to prevent permanent complications. Complications that can be associated with an inverted eyelid include:
- Eye infections
- Corneal abrasions
- Vision loss
Take-Home Message
If you constantly feel like there's something in your eye, or if your eyelid seems to be turning inward, you may have entropion. It's important to get this condition treated to prevent long-term problems like corneal damage and vision loss. Talk to your doctor about treatment options that can improve your discomfort, eye health, and overall quality of life. Don't be afraid or embarrassed to talk about it. The sooner you get treatment, the sooner you can get better!
` Entropion, inward turning of the eyeball, eye diseases, itchy eyes, red eyes, eyesight, aging and eyes
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