Eyelid entropion

Specialty: Ophthalmology.

• inverted eyelid
• eyelashes that touch the eye
• eyelid edge inward

Why it occurs

• Involutional or senile entropion (caused by horizontal laxity of the eyelid and hyperactivity of the pretarsal orbicularis muscle that rotates the eyelid margin towards the cornea)
• Acute spastic entropion (secondary to severe ocular inflammation, surgery or trauma that generates a persistent defensive spasm of the orbicularis muscle)
• Scarrial entropion (due to retraction of the tarsal conjunctiva due to sequelae of ocular pemphigoid, Stevens-Johnson syndrome, trachoma or chemical burns)
• Congenital entropion (due to focal dysgenesis of the lower eyelid retractors)

Initial workup

Slit lamp biomicroscopy to delineate the degree of corneal and conjunctival involvement; Fluorescein staining of the corneal surface; Evaluation of the upper and lower eyelid by forced eversion to examine whether there are conjunctival scars or fibrotic bands (symblepharon) in the internal tarsal conjunctiva.

Standard management

• Epithelializing ophthalmic ointment with Retinol palmitate — vitamin A, apply every 8 hours to the conjunctival sac to accelerate corneal epithelial healing
• Tobramycin — 0.3% eye drops, 1 drop every 6 hours for bacterial prophylaxis of the injured cornea
• Botulinum toxin type A (selective injection of 5 units into the pretarsal orbicularis muscle of the lower eyelid to temporarily paralyze spasmodic muscle fibers in senile or acute spastic entropion, as a temporary measure before definitive corrective surgery).