Entropion Surgery: Everything You Need to Know

Entropion surgery is an outpatient procedure to correct an inverted eyelid. The condition can occur in one eye or in both eyes at the same time.

There are three types of surgery, each of which takes about 45 minutes. Recovery includes limited use of your eyes and limited activities. The full recovery period lasts about a month.

What Is Entropion? Causes, Symptoms, and Diagnosis

Entropion is a condition where the margin of your eyelid, often the lower eyelid, folds inward. This inversion condition causes your eyelashes to rub against your corneal surface, causing irritation. Entropion can occur on the eyelids of one or both eyes.

Causes

Causes of entropion include horizontal eyelid looseness, congenital (genetic) origins, disinsertion or thinning of your eyelid retractors, previous surgery, or inflammation. Aging can also cause entropion by creating loose skin, ligaments, and muscles around the eyelids. Trachoma, an eye infection, can lead to eyelid scarring, which may cause entropion.

Symptoms

The symptoms of entropion include pain, irritation and redness around your eye, dry eye syndrome, sagging skin around your eye, light and wind sensitivity, watery eyes and eye discharge.

Diagnosis

A routine comprehensive eye examination and physical can help diagnose entropion. During a physical examination, an eye doctor will assess the eyelid’s position in your eye and its muscle tone and tightness. 

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When Is Surgery Required?

Healthcare professionals usually recommend surgery to correct entropion when medical management of the underlying causes of the condition is ineffective.

Entropion is a progressive medical condition. Left uncorrected, it can cause considerable damage to your cornea and conjunctiva, potentially leading to corneal disease. There is also the risk of corneal ulcers in advanced cases.

While you may see your primary care provider with symptoms of entropion, referral to an ophthalmologist or oculoplastic surgeon is often recommended. An ophthalmologist will determine the appropriateness of surgical intervention as a long-term solution following a comprehensive examination. 

Types of Entropion Surgery

The type of entropion and the condition of surrounding eyelid tissues determine the type of entropion correction surgery. The three surgeries are:

• Everting/rotational sutures
• Horizontal lid tightening
• Retractor reinsertion

Everting/Rotational sutures

This quick in-office or bedside procedure that offers relief from entropion symptoms.

An eye surgeon uses full-thickness eyelid sutures to tighten your lower lid retractors (muscles that open your eyelid) and prevent your eyelid from folding inward. One downside to this surgery: recurrence is common.

Horizontal Lid Tightening

Performed through a lateral tarsal strip, an eye surgeon splits your eyelid into two thin layers (lamellae) and constructs a tarsal strip from one of the layers.

The surgeon then sutures the tarsal strip to the tissue surrounding your eye socket bone (lateral orbital wall). The procedure increases eyelid tension. 

Retractor Reinsertion

In this surgery, the doctor tightens your eyelid retractors.

The Procedure

Doctors perform entropion surgeries only after they educate you about the benefits and associated risks of the specific procedure. An oculoplastic surgeon or ophthalmologist performs entropion correction as an outpatient procedure.

Before surgery, a local anesthetic will be administered to number your eyelid and the surrounding areas. Depending on your specific procedure, light sedation may be necessary to make you more comfortable. The procedure takes about 45 minutes to complete.

Recovery

Following entropion surgery, your eyelid may feel overly tight. The tightening dissipates as the surgical site heals. Your eye doctor will remove the stitches a week after the procedure. 

Swelling or bruising usually heals completely within two to three weeks. Complete recovery following entropion surgery can take up to four months. The recovery period can vary from patient to patient.

Possible Side Effects and Aftercare

The possible side effects and complications from entropion correction surgery include:

• Blurry or double vision
• Corneal abrasion
• Bleeding
• Infection
• Scarring
• Recurrence
• Overcorrection
• Lower lid retraction
• Wound rupture

Post-operative care following eyelid surgery, including entropion correction surgery, is crucial. Cool compresses can help alleviate the discomfort and swelling.

Your eye doctor may recommend wearing a bandage or eye patch for 24 hours to minimize bleeding and shield your eye from irritants. To further prevent bleeding, your doctors is likely to ask you to restrict any major activity for about two weeks. 

During this rest period, you will also be asked to gently clean your eyelids using a sterile saline solution. Antibiotic ointment is also prescribed for wounds to prevent infection.

You should not wear contact lenses for several weeks following entropion correction surgery.

FAQs

How long does it take to recover from entropion surgery?

Following entropion surgery, swelling and bruising usually heal within two weeks. Full recovery can take three to four months.

What happens if entropion is left untreated?

Left untreated, entropion can cause corneal and conjunctival damage. This can lead to conditions including corneal scarring, stromal abrasion, and thinning. In advanced entropion cases, there is an increased risk of corneal ulcers and perforation.

How much does entropion surgery cost? Costs for entropion surgery range between $500 and $2,000. You may also incur additional costs, including anesthesia, medication, consultation and aftercare appointments. Prices vary considerably depending on where you have the surgery done, the type of procedure, and the degree of your entropion.

References

1. Entropion Eyelid Reconstruction. (February 2022). National Center for Biotechnology Information.

2. Entropion. (January 2022). StatPearls.

3. Does Medicare Cover Eyelid Surgery. (October 2021). Help Advisor.

4. Entropion. (October 2021). American Academy of Ophthalmology.

5. Eyelid Surgery: What to Expect at Home. (March 2021). MyHealthAlberta.

6. Lower Lid Tarsal Strip for correction of ectropion. (March 2018). University of Iowa Health Care.

7. Diagnosis and Management of Involutional Entropion. (February 2016). American Academy of Ophthalmology. EyeNet Magazine.

8. Surgical management of entropion. (October 2010). Ophthalmologe.

9. Corner Sutures for Entropion. AEDIT.