Generality
Entropion is the inward rotation of the eyelids. In the presence of this condition, with each movement of the eye the eyelashes and the lid margin rub against the front of the eye, causing redness and irritation.
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Entropion can affect people of any age group, but is more common among the elderly. The condition occurs mainly as a consequence of the aging process, due to the laxity of the eyelid tendons associated with the weakening of the muscles and the sagging of the skin. Entropion can also occur as a result of injury, trauma or previous surgery. The disorder can affect one or both eyes and mainly involves the lower eyelid.
Some treatments are available to temporarily relieve symptoms and protect the eye from potential damage, however, the most effective correction remains surgery.
Symptoms
As the eyelid rotates inward, the lashes come into close contact with the eyeball and begin to scratch the cornea. For this, the most common symptoms of entropion include:
- Redness of the eyes;
- Pain around the eye;
- Sensitivity to light and wind;
- Skin relaxation around the eyes;
- Epiphora (excessive lacrimation with extravasation on the face, rather than through the nasolacrimal system);
- Decreased vision, especially if the cornea is damaged.
Entropion can also create secondary eye pain (due to injury to the eyelid or nerve damage).
Often, the symptoms of entropion develop with a slow progression. The onset typically manifests as mild eye irritation but over time, in the absence of treatment, repeated abrasion of the cornea can lead to infection, scarring and loss of vision. .
Complications
In case of extreme dry eye or chronic irritation, corneal lesions can turn into ulcerations (sore on the cornea). A corneal ulcer can become infected and can cause severe vision loss if not treated promptly.
Causes
Entropion can be caused by a number of causes.
- Aging process: represents the most common cause of entropion. As we age, the tissues around the eyes begin to loosen and weaken, allowing the edge of the eyelid to turn inward;
- Scarring: This can be the result of injury, trauma, infection, previous surgery, radiation therapy, or chemical burns. Scars can alter the normal curvature of the eyelid and cause entropion;
- Muscle spasms: spastic entropion is a consequence of ocular muscular alterations, which can derive from infections or inflammations;
- Congenital conditions: very rarely, entropion is present at birth as a developmental complication;
- Trachoma: Entropion is one of the characteristic symptoms of trachoma, an infectious disease of the eye most common in developing countries. This disease is easily transmitted through direct contact with the eyes and nose of an infected person or by sharing personal items, such as towels and clothing. Trachoma is the world's leading cause of infectious blindness.
Diagnosis
The ophthalmologist can easily diagnose entropion during an eye exam. This may involve assessing the muscle tone and hyperlaxity of the eyelid tissues. In cases where the condition is suspected to be caused by the presence of scarring or previous surgery, the doctor will also check the surrounding tissue.
Determining the cause of entropion allows you to establish the most appropriate therapy or surgical technique.
Treatment
Treatment depends on the cause and severity of the entropion; in particular, the condition of the cornea affects the choice of therapy to be adopted.
If the cause is minor and temporary, eyelid taping can relieve symptoms. This procedure consists in applying the patches, according to the methods and times indicated by the doctor, in order to create a tension that causes the ciliary margin to overturn towards the outside.
Injections of botulinum toxin A can be used to achieve the same result, especially if the entropion is caused by muscle spasms. This treatment weakens the spastic muscles even if the effect lasts a few months. In the meantime, antibiotic, re-epithelializing, or lubricating eye drops or ointments are often prescribed to keep the eyes moist, relieve symptoms, and protect the cornea. Alternatively, therapeutic contact lenses may be prescribed to protect the corneal surface.
If the condition is unlikely to recover spontaneously, the patient may undergo surgery. Several procedures are available and the technique used depends on the etiology and condition of the surrounding tissue. If entropion is caused by hyperlaxity of the eyelid tissues, due to aging, the procedure involves removing the excess skin from the eyelid. and the application of one or more sutures to stretch muscles and tendons and turn the eyelid into its natural position. In the event that entropion is caused by scarring caused by trauma or previous surgery, the surgeon may use a skin graft. If the surgery is performed before the cornea is damaged, the prognosis is excellent. Over time, the prognosis is excellent. it is however possible to repeat the surgery to further correct the laxity of the eyelid.
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