Generality
The entropion consists in the rotation towards the inside of the eyelids. In the presence of this condition, with each movement of the eye the eyelashes and the eyelid margin rub against the front of the eye, causing redness and irritation.
The entropion can affect subjects 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 weakening of the muscles and sagging skin. Entropy 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
When the eyelid rotates inward, the eyelashes tighten in contact with the eyeball and begin to scratch the cornea. Therefore, the most common symptoms of entropion include:
- Redness of the eyes;
- Pain around the eye;
- Sensitivity to light and wind;
- Cutaneous relaxation of the eye contour;
- Epiphora (excessive tearing with extravasation on the face, rather than through the nasolacrimal system);
- Decreased vision, especially if the cornea is damaged.
The entropion can also create secondary eye pain (due to injury to the eyelid or nerve damage).
Often, entropion symptoms develop with slow progression. Onset typically occurs as a slight eye irritation but over time, in the absence of treatment, repeated abrasion of the cornea can lead to infection, scarring and vision loss.
Complications
In the case of extreme dry eyes or chronic irritation, corneal lesions can be transformed into ulcerations (sore on the cornea). A corneal ulcer can become infected and can cause severe vision loss, if not treated promptly.
Causes
The 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;
- Scars : may result from injury, trauma, infection, previous surgery, radiotherapy or chemical burns. Scars can alter the normal curvature of the eyelid and cause entropion;
- Muscle spasms : the spastic entropion is consequent to ocular muscular alterations, which can derive from infections or inflammations;
- Congenital conditions : very rarely, entropion is present at birth, as a complication of development;
- Trachoma : entropion is one of the characteristic symptoms of trachoma, an infectious disease of the eye most prevalent in developing countries. This condition 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 blindness of infectious origin.
Diagnosis
The ophthalmologist can easily diagnose entropion during an eye examination. This may involve the assessment of muscle tone and hyperlitement of the eyelid tissues. In cases where the condition is suspected to be caused by the presence of scarring or a 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 taken.
If the cause is minor and temporary, taping the eyelid can alleviate the symptoms. This procedure consists in applying the patches, according to the procedures and times indicated by the doctor, in order to create a tension that causes the ciliary margin to flip outwards.
Botulinum toxin A injections 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. Meanwhile, it is often prescribed an eyewash or an ointment based on antibiotics, re-epithelizing or lubricants, to keep the eyes moist, alleviate the symptoms and protect the cornea. Alternatively, therapeutic contact lenses can be prescribed to protect the corneal surface.
If the condition is unlikely to recover spontaneously, the patient may undergo surgery. Different procedures are available and the technique used depends on the etiology and condition of the surrounding tissue. If the entropion is caused by the hyper-quality of the eyelid tissues, due to aging, the procedure involves the removal of excess skin from the external eyelid and the application of one or more stitches to stretch muscles and tendons and turn the eyelid in its natural position. If the entropion is caused by scars caused by traumas or previous surgical procedures, the surgeon can use a skin graft. If surgery is performed before the cornea is damaged, the prognosis is excellent. Over time, it is still possible to repeat the surgery to further correct the laxity of the eyelid.
