ConditionEyes & vision
Entropion (Inward-Turning Eyelid)
Entropion is a condition in which the eyelid, usually the lower lid, turns inward so the eyelashes and skin rub against the surface of the eye. It causes a gritty, scratchy feeling, redness, watering, discharge and sensitivity to light. It is most common in older adults because the eyelid tissues loosen with age. Lubricating drops and taping the lid give temporary relief, but a short outpatient operation is usually needed to fix it permanently and protect the cornea from scratches and ulcers.
Also called: Inward-turning eyelid, eyelid inversion, involutional entropion
At a glance
- What it is
- The eyelid margin rolls inward so lashes rub the eye.
- Most common type
- Age-related (involutional) entropion of the lower lid.
- Symptoms
- Gritty feeling, redness, watering, discharge, light sensitivity.
- Risk if untreated
- Corneal scratches, ulcers, infection and scarring that can affect vision.
- Treatment
- Lubricants, tape or a bandage contact lens short term. Eyelid surgery is the definitive fix.
When to get help
Call 911 or go to the ER
- Sudden severe eye pain with vision loss
See a doctor within a day or two
- Increasing eye pain, light sensitivity, blurred vision or a white spot on the cornea (possible corneal ulcer)
- Thick yellow or green discharge with a very red eye
- Eye symptoms in someone who wears contact lenses
Book a routine appointment
- An eyelid that seems to roll in, with lashes touching the eye
- Ongoing irritation, watering or a feeling of something in the eye
- Recurrent eye infections or redness
Usually safe to manage at home
- Mild irritation while waiting for an appointment, eased with lubricating drops and ointment
How entropion develops
Normally, the eyelid margin sits flat against the eye with the lashes pointing outward. In entropion, the lid margin rolls inward. Each blink drags the lashes and lid skin across the cornea, the clear front window of the eye. Over time this can cause abrasions, infection and scarring.
Entropion may be constant or intermittent, appearing when you squeeze your eyes shut or look down.
Types and causes
| Type | Cause | Who gets it |
|---|---|---|
| Involutional (age-related) | Loosening of the eyelid tendons and weakening of the muscles that hold the lid in place, with overaction of the muscle around the eye | Most common. Adults over 60, lower lid |
| Cicatricial (scarring) | Scarring of the inner eyelid lining pulls the margin inward | Trachoma, chemical burns, injury, surgery, autoimmune conditions such as ocular cicatricial pemphigoid, Stevens-Johnson syndrome |
| Spastic | Eyelid muscle spasm, often after eye surgery, irritation or blepharospasm | Usually temporary |
| Congenital | Present at birth | Rare. Different from epiblepharon, a common harmless fold in infants |
Worldwide, scarring from trachoma, a chlamydia infection of the eye spread in areas with poor sanitation, is a leading cause of entropion and blindness.
Symptoms
- Feeling that something is in the eye
- Redness and irritation
- Watering, sometimes alternating with dryness
- Mucus discharge or crusting
- Sensitivity to light and wind
- Eye pain if the cornea is scratched
- Blurred vision if the cornea is damaged
Entropion vs ectropion vs trichiasis
| Condition | What happens |
|---|---|
| Entropion | Eyelid turns inward, lashes rub the eye |
| Ectropion | Eyelid turns outward, exposing the inner lining, causing dryness and watering |
| Trichiasis | Individual lashes grow toward the eye, but the lid position is normal |
Diagnosis
An eye doctor examines the eyelid position and tone, often asking you to squeeze your eyes shut, which can bring on intermittent entropion. A snap-back test and pulling the lower lid away from the eye show how loose it is. A slit lamp examination with fluorescein dye checks the cornea for scratches or ulcers. If scarring is present, doctors look for an underlying cause.
Treatment
Short-term relief
- Lubricating eye drops and ointment to protect the cornea and ease irritation
- Skin tape: taping the lower lid down and out to hold the margin in position
- Bandage soft contact lens to protect the cornea
- Botulinum toxin injection to weaken the overactive muscle, giving relief for a few months
- Everting sutures: stitches placed in clinic to turn the lid out, often a temporary solution
- Antibiotic drops if there is infection or a corneal abrasion
Surgery
Surgery is the definitive treatment, usually done as a day procedure under local anesthetic. For age-related entropion, the surgeon tightens the loose eyelid (often by shortening it horizontally) and reattaches or strengthens the retractor muscles that pull the lid down. Scarring entropion may need grafts of tissue to lengthen the inner lid lining. Most people recover within 1 to 2 weeks, with bruising and swelling settling over that time. Success rates for age-related entropion surgery are high.
Complications if untreated
- Corneal abrasions (corneal abrasion)
- Corneal ulcers and infection
- Corneal scarring and permanent vision loss
- Chronic eye discomfort
Frequently asked questions
What causes entropion?
The most common cause is aging, which loosens the tendons and weakens the muscles that hold the lower eyelid in place. Scarring from infections such as trachoma, chemical burns, injuries and autoimmune conditions can also pull the lid inward. Eyelid spasm after eye surgery causes temporary entropion.
Is entropion serious?
It can be. The rubbing lashes can scratch the cornea, leading to ulcers, infection and scarring that may affect vision. Increasing pain, light sensitivity or blurred vision need prompt attention. Surgery usually corrects the problem and prevents damage.
Can entropion be fixed without surgery?
Lubricating drops, taping the eyelid, a bandage contact lens or botulinum toxin injections can relieve symptoms temporarily. Spastic entropion may resolve on its own. For age-related and scarring entropion, surgery is usually needed for a lasting fix.
What is the difference between entropion and ectropion?
In entropion, the eyelid turns inward, so lashes rub against the eye. In ectropion, the eyelid turns outward, leaving the inner surface exposed, causing dryness, redness and watering. Both are common in older adults and are usually corrected with eyelid surgery.
Sources
This guide was written from current patient and clinical guidance, including:
- American Academy of Ophthalmology: Entropion
- American Society of Ophthalmic Plastic and Reconstructive Surgery: Entropion
- MedlinePlus: Entropion
- NHS: Entropion
- World Health Organization: Trachoma fact sheet