Entropion vs Ectropion

Dr Ben Wild

Overview

The eyelids are made up of various types of skin, muscle, glands, hair follicles and much more. Their purpose is to protect the eyes from dryness, bright lights and irritants.

Frontal view of a healthy eye.

Eyelid entropion occurs when, in most cases, the lower eyelids turn inwards towards the eye. This can occur due to the presence of an extra layer of skin normally found on babies (epiblepharon). It can also be due to scarring on the conjunctiva (the inner eyelid skin), or loss of muscle tone due to old age. This condition leads to the eyelashes scratching the eyes.

Frontal view of entropion. The upper lid is turned inwards.

Eyelid ectropion refers to a condition, where again, in most cases, the lower eyelids lose contact with the eye and pout outwards. This usually occurs due to loss of skin elasticity or muscle tone due to age, scarring of the skin below the eyelids, or Bell’s palsy. If the eyelid is turned outwards, the tears cannot exit the eye through the puncta to the nose resulting in tears running down one’s cheek.

Frontal view of ectropion. The lower lid is turned outwards.

Signs and Symptoms

Signs

Usually bilateral turning of the eyelids inwards (entropion) or outwards (ectropion), red and inflamed eyelids, red eyes, tearing, and tears running down cheeks, recurrent eye infections.

Symptoms

Dry eyes, gritty eyes, foreign body sensation, corneal ulceration.

Causes and Risk Factors

Entropion: the presence of epiblepharon, loss of certain eyelid muscles and chemical burns or skin conditions that cause scarring to the inner eyelid skin.

Ectropion: loss of eyelid muscles that hold the eyelids to the eyes often due to age, large weight loss, etc., chemical burns or skin conditions that cause scarring of the outer eyelid skin, Bell’s palsy or other facial nerve palsies, Botox injections, and growths on the outer eyelids.

Prevention and Treatment

Prevention

Avoid chemical or thermal burns and treat skin conditions that can cause scarring in conjunction with a dermatologist.

Treatments

Treatments usually start by managing the symptoms and when severe, surgery can be corrective. Managing the symptoms can include artificial tears, taping the eyelids into position, bandage contact lenses, Botox injections, or even a tarsorrhaphy (stitching the eyelids partially closed). Otherwise, corrective procedures include eyelid surgery.

Prognosis

Even though surgery can be corrective, it usually does not “fix” all of the associated symptoms of dry eyes caused by eyelid entropion or ectropion. Managing these symptoms post operatively requires daily routine changes, but these habits are usually easily maintained. In an infant, if entropion is noticed due to the presence of epiblepharon, there is usually no treatment as it goes away as the child grows. If managed properly, there should be no permanent damage to the eyes or loss of vision.