The eyelids play a crucial role in protecting the eyes. They serve as natural barriers that shield against external irritants, regulate the amount of light entering the eye, and help distribute the tear film evenly across the ocular surface to maintain moisture and clear vision. When the eyelid position becomes abnormal—such as in entropion or ectropion—these protective mechanisms are disrupted, leading to discomfort and potentially more serious ocular complications. Understanding the causes and treatment options for eyelid malposition is essential for early detection and appropriate management.
Entropion refers to a condition in which the eyelid margin—including the eyelashes—turns inward, causing the lashes and eyelid skin to rub against the surface of the eye. This condition most commonly affects the lower eyelid. The friction between the eyelashes or eyelid skin and the ocular surface leads to foreign-body sensation, irritation, and pain, and may damage the cornea (the transparent front part of the eye) and the conjunctiva (the thin membrane covering the sclera and inner eyelid). If left untreated, chronic friction can cause corneal scarring, ulceration, infection, and even vision loss.
The most common type. It results from age-related weakening and laxity of the eyelid muscles and supporting ligaments, causing the eyelid to lose stability and turn inward.
This form is caused by scarring and contraction of the conjunctiva (the inner layer of the eyelid). It may result from trauma, inflammation, or previous ocular surgery, leading to shortening of the posterior lamella and inward rotation of the eyelid.
Present at birth. It may be caused by abnormal development of the lower eyelid retractors, excess skin folds pushing the lashes inward, or anterior displacement of the mucocutaneous junction, which moves the lash line closer to the globe. This displacement can sometimes be associated with chronic blepharitis.
Different types of entropion reflect a variety of underlying mechanisms, making accurate diagnosis essential for selecting the appropriate treatment strategy. For example, cicatricial entropion requires management of scar tissue, while involutional entropion focuses on tightening lax structures.
The primary symptoms of entropion result from the eyelashes and eyelid skin rubbing against the ocular surface:
Surgery for entropion aims to restore the eyelid to its correct anatomical position, thereby protecting the eye from further damage and alleviating associated symptoms.
This procedure corrects entropion by either removing a portion of skin or muscle externally (vertical shortening) or by everting the eyelashes to rotate the eyelid outward.
This procedure is commonly used for involutional (age-related) entropion. A small segment of the outer portion of the lower eyelid is removed, and the remaining edges are sutured together to shorten the horizontal length of the eyelid. This tightening helps restore the eyelid to its proper anatomical position.
For cicatricial entropion, when the posterior lamella of the eyelid is deficient, a graft may be harvested and placed within the inner eyelid to restore adequate tissue length. This added support helps return the eyelid to its normal anatomical position.
This is a two-step procedure. First, the eyelid is divided at the grey line. Then, the anterior lamella (skin and muscle) is recessed, and everting sutures are placed to enhance outward rotation of the eyelid.
One Week Before Surgery:
・Discontinue anticoagulant medications (such as aspirin). Please confirm with your prescribing physician whether temporary discontinuation is appropriate.
・Stop taking all nutritional supplements (such as fish oil, ginkgo, ginseng, and vitamin E).
・Avoid smoking and alcohol from one week before surgery until one month after the procedure.
On the Day of Surgery:
・Please arrive with a clean face and no makeup; remove any eyelash extensions.
・Do not wear any accessories or metal items. If you have piercings, please remove them in advance.
・If you are nearsighted, you may wear contact lenses to the clinic, but they must be removed before surgery. Please bring a storage case, eyeglasses, or sunglasses for use afterward.
・Local anesthesia does not require fasting, and you may eat and drink as usual.
・General anesthesia requires fasting for approximately 8 hours. Please avoid all food and drinks, including water and chewing gum.
・Please do not drive or ride a motorcycle yourself after the procedure.
・Cold and Warm Compresses: Apply cold compresses during the first 72 hours after surgery to help reduce swelling and bruising, and keep your head elevated as much as possible. Warm compresses may be started after 72 hours to promote circulation and healing.
・Wound Care and Dressing Changes: Keep the incision area clean and dry after returning home, and change dressings as instructed. If skin sutures are present, they are typically removed around 6–10 days postoperatively, depending on wound condition.
・How to Change Dressings: Clean the wound twice daily using sterile cotton swabs dipped in normal saline, dry the area, and then apply the prescribed ointment. When performing cold or warm compresses, place a piece of gauze over the wound to reduce the risk of infection.
・Medication and Eye Hygiene: Use the prescribed eye drops or ointment as directed to prevent infection and support healing.
・Eye Use and Daily Habits: Avoid prolonged use of mobile phones, computers, or looking down for extended periods. Allow your eyes sufficient rest to facilitate recovery.
・Diet and Medications:
- You may take the prescribed pain relievers as needed to ease postoperative discomfort.
- Avoid irritants such as smoking, alcohol, tea, coffee, spicy foods, and dietary supplements (including vitamin E, lingzhi, and traditional herbal medicine).
- A light diet is recommended, along with adequate hydration and increased intake of protein and vitamin C to support wound healing.
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2F, No. 263, Sec. 1, Dunhua S. Road,Da'an District, Taipei City 106, Taiwan
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