Ectropion and Entropion

Your eyelids protect your eye and spread tears across it every time you blink. To do this well, the lid edge must sit snugly against the eye.

• Ectropion is when the eyelid edge turns outwards, away from the eye. The pink inner lining of the lid can be seen. Tears do not drain properly, and the eye is left exposed [1][2].
• Entropion is when the eyelid edge turns inwards, towards the eye. The eyelashes rub against the cornea (the clear window at the front of the eye) every time you blink [3].

Both usually affect the lower eyelid, and can happen in one or both eyes.

What causes it?

• Age-related (involutional): the most common cause of both. The eyelid and its supporting tendons become loose with age [2][3].
• Scarring (cicatricial): scar tissue shortens the skin (ectropion) or the inner lining (entropion) and pulls the lid out of place [2][3].
• Facial nerve palsy (paralytic): the muscle that holds the lower lid up becomes weak, so the lid sags outwards [2].
• Lumps (mechanical): a growth on the lid can push or pull it out of place [2].
• In children (epiblepharon): some children, especially of East Asian background, have an extra fold of skin under the lower lid that pushes the lashes against the eye. It is not true entropion. Many children have no problems and only need lubricant drops and checks, but some need a small operation if the cornea is being damaged [4].

Your risk is higher if you:

• are older, as the eyelid tissues become loose and stretchy with age [2][3]
• have had a facial nerve palsy (weakness of one side of the face, such as Bell's palsy), which can cause ectropion [1][2]
• have scarring of the eyelid skin or the inner lining of the lid, from burns, injury, surgery, or chemical injury [1][3]
• have had eye conditions that scar the lid lining, such as trachoma (an eye infection) or Stevens-Johnson syndrome (a severe reaction, often to a medicine) [3]
• have a lump on the eyelid that pulls it down [1]

You may see that the lower lid sags away from the eye or that the lashes point inwards. An eye doctor can usually diagnose it just by looking. They will also:

• check whether the lid is loose
• use a special dye and blue light to look for scratches on the cornea
• look for scarring or a lump on the lid
• check your face movements if a nerve problem is suspected

What can happen?

With ectropion:

• Watering eyes, because tears cannot reach the tear drain
• Dry, gritty, red eyes, and a sore, red lid edge
• Repeated infections such as conjunctivitis
• Damage to the cornea from being exposed and dry

With entropion:

• A scratchy, gritty feeling, like something is in the eye
• Redness, watering and sensitivity to light
• Scratches on the cornea that can turn into a corneal ulcer (an open sore, which can get infected). This can scar the cornea and affect your vision [3].

See an eye doctor soon if:

• your eye is constantly gritty, red or watering
• you have had a facial palsy and cannot close your eye fully

Treatments to protect the eye while waiting (temporary)

1. Lubricant drops and ointment to keep the eye moist and comfortable [1][2].
2. Taping the lid: special skin tape can hold the lid in a better position, or help keep the eye closed at night [1][3].
3. Bandage contact lens: a soft lens that shields the cornea from rubbing lashes (entropion).
4. Botulinum toxin (Botox) injection: can relax the muscle that rolls the lid inwards. The effect lasts a few months (entropion) [3].

Surgery (the long-term fix)

Surgery is the main treatment for both conditions [2]. The surgeon tightens the loose eyelid and puts it back in the right position. For scarring, a skin or tissue graft may be needed. It is usually done under local anaesthetic (you are awake but the area is numb) as a day case, and takes under an hour [5]. Afterwards, the eyelid may be bruised and swollen for one to two weeks [5]. Sometimes the problem comes back, especially after scarring, and needs another operation [3][5].

If ectropion is caused by a facial palsy, the eye doctor will also focus on protecting the cornea, as the eye may not close properly.

Age-related ectropion and entropion cannot always be prevented, but you can protect your eye:

• Do not rub your eyes, and dab tears away gently with a clean tissue [1].
• Protect your eyes from chemicals and injury with goggles at work and at home.
• Do not pull out lashes yourself; see an eye doctor instead.
• Get a gritty, watery, red eye checked early, before the cornea is damaged.

Where to get help in Brunei

You can walk in to any Community Eye Clinic at your health centre. No referral is needed. The team can check your eyelids and refer you to the eyelid (oculoplastic) specialists if surgery is needed.

For a very painful red eye with blurred vision, go to the hospital Emergency Department.