Entropion and things you need to know

Although the eyelashes are small parts of the eye, they protect the eyes from environmental factors such as sunlight, wind, and dust. However, this eyelid area can be affected without careful care and cause various potentially dangerous conditions, including entropion (or eyelid malposition).

Entropion eyelashes cause difficulty with vision.

What is entropion?

Entropion, also known as eyelid malposition, is a condition where the eyelid margin rolls inward towards the eyeball. It causes the eyelashes to rub against the eye, resulting in redness, irritation, and scratching of the eye’s cornea. This constant friction between the cornea and conjunctiva leads to damage.

Although the symptoms are localised to the eyelash area, this condition causes discomfort and pain for the affected individuals. Left untreated, it can lead to corneal scarring and increase the risk of corneal inflammation and ulcers. More dangerously, this condition can cause a significant decrease in visual acuity and even complete blindness.

How does entropion affect visual health?

Entropion is a condition in which the eyelashes twist together or curl up, causing discomfort to the eye and potentially affecting vision health. When the eyelashes curl inwards, they obstruct your vision and make reading or driving difficult. Left untreated, it can lead to other issues such as eye infections, dry eyes, and eyelash loss. Therefore, it is essential to treat eyelid malposition to protect your vision health.

Some impacts of entropion on vision health are:

• It causes eye strain and discomfort. When eyelashes cramp, they can squeeze on the area around the eyes, causing pain and eye strain.
• It causes swelling and inflammation of the eyelids. Eyelid malposition can also cause skin irritation around the eye, leading to swelling, inflammation, and itching.

Is entropion dangerous?

• Causes dry eyes. Entropion can also reduce the amount of oxygen and water vapour entering the eyes, causing dry eyes and discomfort.
• Causes of corneal damage. If the lash is too severe, it can cause damage to the cornea, the white area of the eye, causing serious vision problems.
• Causes infection. If the eyelid contains dust, bacteria, or viruses, it can lead to infection of the area around the eyes.

Causes of entropion

There are many causes of eyelid malposition, but most often, it is due to one of the following:

• Congenital entropion. This condition turns the eyelid margin inward, causing the eyelashes to rub against the cornea. The underlying cause is a structural defect in the eyelid cartilage, leading to increased muscle tension and excess skin. It is commonly seen in newborns. The condition can worsen if left untreated, causing corneal inflammation, ulceration, and scarring. Consequently, it can have long-term effects on the child’s vision.
• Age-related entropion. The most common cause is ageing. The ageing process leads to the loosening of the supporting tissues, resulting in eyelid malposition. This condition causes itching, discomfort, excessive tearing, redness, and other symptoms.
• Entropion due to contracture. This usually occurs in the lower eyelids. People with trauma after surgery or inflammation in the eyes may develop chronic eyelash spasms. Prolonged squinting causes the eyelashes to get swept inward, causing eyelid malposition.
• Entropion due to scars. This is a complication of conjunctival and cartilage diseases such as trachoma, Stevens-Johnson syndrome, chemical burns, and Pemphigut disease … The eyelid cartilage is bent inward; the corneal conjunctiva is scarred, sometimes with partial eyelash adhesions.

Signs to identify entropion

Entropion is a common problem that many people face. However, not everyone knows how to recognise signs of eyelid malposition. Below are some signs of cramped eyelashes that you should be aware of:

 Image depicting entropion of the lower eyelid

• The eyes feel bloated and porous and seem to have foreign objects in the eye.
• Redness and blurred vision.
• Eye pain when looking at bright objects or bright light sources.
• Sticky discharge and hard scales on the eyelashes.
• Frequent itching and discomfort in the eye.
• Frequent tearing of the eye.

Specifically, when the eyelashes rub against the cornea, it causes discomfort in the eye. Over time, this can lead to damage and cause corneal abrasions. If the condition worsens and lasts for a long time, it can cause corneal ulceration, leaving unsightly scars and reducing vision.

Treatment of entropion

In case of suspected entropion, the doctor will use a comprehensive slit lamp to examine the front part of the eye. From there, the distribution of cramped eyelashes can be assessed, and the cause can be determined and distinguished from other diagnoses.

Patients can use tape to pull the lashes outwards if the eyelashes are cramped. Lubricants can be applied to the eye to reduce friction. Additionally, antibiotics can be used to prevent infection.

Does treating entropion have to be surgical?

Methods such as electric cauterisation, cold compression, or laser may be applied for mild eyelid malposition cases (only a few cramped hairs and no complications). However, these methods often have low effectiveness and are prone to recurrence, so they must be performed multiple times.

Therefore, to radically improve the entropion condition, doctors recommend surgery to tighten the eyelid and hairline and re-establish the normal position of the eyelashes. Surgery will help delay when the corneal surface is intact. At the same time, the skin on the temporal side of the eyelash can be suspended or temporarily sewn to protect the eyes from further damage.

Surgical repositioning of eyelashes/hair follicles

• For cases of horizontal or lower eyelid entropion. Doctors will reattach the lower eyelash withdrawal muscle while removing the cartilage layer.
• For cases of scarring in the posterior layer: The thin layers and rear dome can often be extended using grafts.

Eyelash/follicle removal surgery

This method is applied when eyelid malposition occurs in parts or locally. For eyelash/follicle surgery, there are two ways to do it: using forceps or electric eyelash removal.

Using regular forceps to pluck hair is simply a timely treatment measure because it still leaves hair follicles. At that time, eyelashes that grow back can be even more challenging and uncomfortable. In contrast, electric eyelash removal is thought to be more effective but requires pain and suffering.

In addition to surgical intervention, patients may be prescribed medical treatment if the condition is severe, such as Stevens-Johnson syndrome or blisters with eye scars.