Treatment of Entropion
Surgical correction is the definitive treatment for entropion, addressing the underlying anatomical abnormalities that cause the eyelid to turn inward against the globe. 1, 2
Clinical Assessment Before Treatment
Evaluate the specific type and severity of entropion through:
- Direct examination of eyelid margin position and degree of inward rotation 3
- Provocation testing including forced eyelid closure, the test of induced entropion (TIE), or the TIE-2 test (patient looks down while examiner holds upper lid open, then patient closes eyes tightly) to diagnose intermittent cases 4
- Assessment of corneal damage using fluorescein staining to identify superficial punctate keratitis, corneal abrasions, or ulceration 5, 2
- Evaluation of horizontal lid laxity with the snapback test 5
- Identification of underlying mechanisms: horizontal lid laxity, lower lid retractor weakness/disinsertion, and orbicularis oculi override 1, 3
Treatment Algorithm by Type
Congenital Entropion
- Observation for first 12 months of life as most cases resolve spontaneously without surgical intervention 1
- Surgery only if persistent beyond infancy or causing significant corneal damage 6
Spastic/Inflammatory Entropion
- Treat the underlying inflammation as the entropion typically resolves with successful management of the inflammatory condition 1
Involutional (Senile) Entropion
This is the most common type requiring surgical intervention 2:
Primary surgical options include:
- Everting sutures (Quickert procedure) for cases with minimal horizontal laxity 2
- Transverse blepharotomy with marginal rotation (Wies procedure) addressing the inward rotation component 1, 2
- Combination procedures addressing both horizontal laxity (lateral tarsal strip) and vertical instability (lower lid retractor advancement) 3, 2
- Orbicularis transfer technique when orbicularis override is the dominant mechanism 2
Cicatricial Entropion
- Free mucosa grafts may be necessary when entropion results from conjunctival scarring due to chronic inflammation or trauma 1
- Surgery must address both the cicatricial component and any associated horizontal/vertical lid instability 3
Conservative Management (Temporizing Only)
Conservative measures provide only temporary relief and are used when surgery is not immediately feasible 1:
- Artificial tears and lubricating ointments to protect the corneal surface 5
- Warm compresses for symptomatic relief 5
- Temporary taping of the lower lid in an everted position
Critical limitation: Conservative treatment does not address the underlying anatomical defect and documented corneal damage (SPK, conjunctival injection) indicates ongoing injury requiring definitive surgical correction 5
Surgical Planning Considerations
- Identify all contributing factors: horizontal laxity, retractor weakness, and orbicularis override must each be addressed to prevent recurrence 3
- Avoid overcorrection: Excessive tightening or rotation can cause iatrogenic ectropion 1
- Bilateral cases: When both eyelids are affected with documented corneal damage, bilateral repair is indicated to prevent progressive corneal epithelial breakdown, ulceration, and chronic symptoms 5
Risks of Delayed Treatment
Untreated entropion with persistent trichiasis leads to:
- Progressive corneal epithelial damage and worsening exposure keratopathy 5, 2
- Corneal ulceration with risk of microbial keratitis 2
- Corneal vascularization and scarring 2, 6
- Visual loss from chronic corneal damage 1, 2
Prompt surgical intervention is essential when corneal damage is documented, as conservative measures will not prevent ongoing injury 5.