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Symptoms ⬇

Irritation, foreign-body sensation, tearing, and redness.

Signs ⬆ ⬇

(See Figure 6.4.1.)

Critical

Inward turning of the eyelid margin that pushes otherwise normal lashes onto the globe.

Other

SPK from eyelashes contacting the cornea, conjunctival injection. Corneal epithelial defect, thinning, and/or ulceration in severe cases.

6-4.1 Entropion.

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Etiology ⬆ ⬇

  • Involutional: Age-induced horizontal eyelid laxity, retractor disinsertion, and orbicularis override.
  • Cicatricial: Due to conjunctival scarring in mucous membrane pemphigoid, Stevens–Johnson syndrome, chemical burns, trauma, trachoma, and others.
  • Spastic: Sustained orbicularis contraction due to surgical trauma, ocular irritation, or blepharospasm.
  • Congenital.

Work Up ⬆ ⬇

Workup
  1. History: Previous surgery, trauma, chemical burn, or infection (trachoma, herpes simplex, varicella zoster)?
  2. Slit lamp examination: Check for corneal involvement and conjunctival or eyelid scarring.

Treatment ⬆ ⬇

If blepharospasm is present, see 6.7, BLEPHAROSPASM.

  1. Aggressive lubrication and antibiotic ointment (e.g., erythromycin or bacitracin q.i.d.).
  2. Everting the eyelid margin away from the globe and taping it in place with lateral traction may be a temporizing measure.
  3. For spastic entropion, a Quickert suture placed at the bedside or in the office can temporarily resolve the eyelid malposition by tightening the lower eyelid retractors and rotating the eyelid margin anteriorly.
  4. Surgery is often required for permanent correction.

Follow Up ⬆

If the cornea is uninvolved, the condition does not require urgent attention or follow up. If the cornea is significantly damaged, aggressive treatment is indicated (see 4.1, SUPERFICIAL PUNCTATE KERATOPATHY). Follow up is determined by the severity of corneal involvement.