Ectropion and entropion are common maladies of the eyelid margin that can directly affect ocular function and patient comfort; surgical repair is commonly performed.
Entropion (in-turning of the eyelid) presents as an irritated eye with foreign-body sensation caused by inwardly rotated eyelashes and eyelid skin. The eye is red from keratoconjunctivopathy. Affected individuals often devise home remedies, such as taping the lid down to the cheek to rotate it away from the globe for comfort.
Like ectropion, entropion is classified into distinct categories on the basis of etiology, as follows:
Congenital entropion – Commonly affecting the lower lids, this is a roll of pretarsal skin that abuts the lashes and rotates them inward; it is quite common in persons of Asian descent and usually resolves as the face matures; if it does not, excision of the skin roll with suture closure is used as a remedy, with minimal scarring and little aesthetic downside
Cicatricial entropion – This results from scarring of the palpebral conjunctival or tarsoconjunctival tissue, leading to inward rotation of the lid margin; worldwide, trachoma is the most common cause, with others including chemical burns, cicatrizing diseases, and trauma; treatment involves addressing the underlying problem with immunosuppression (in the case of ongoing cicatrizing disease) or scar release and grafting; suture rotation repair of the lid margin, with or without lid fracturing techniques, may be appropriate for less severe forms of the disease or cases where the availability of supplies and practitioners is limited
Involutional entropion – This results from a triad of conditions, (1) dehiscence of the lower-lid retractors from the inferior tarsal border, (2) horizontal lid laxity, and (3) relative enophthalmos of the globe; the effect of relative enophthalmos is best appreciated by having the patient lie in the supine position, which typically elicits the transient entropion as the globe sinks into the eye socket