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Entropion

The term entropion is used to describe the condition where an eyelid, usually the bottom eyelid, turns inward to such an extent that the lower eyelashes either occasionally or continually touch the cornea at the front of the eye.

It sounds quite painful – and it is!

Hairs on the body – which is what eyelashes are – can be extremely strong and in fact can cause quite dangerous effects when growing into the body in terms of infection.

It comes as no surprise then that long term continual touching and rubbing by eye lashes can cause the eye to water excessively due to the excessive irritation. Without prompt treatment there are the possibilities of infection or that corneal abrasions will cause ulcers to form.

Who gets it?

Infants and small children occasionally suffer from entropion, however these cases often go undiagnosed as the hairs are soft and cause little discomfort and the condition is often temporary.

In the case of small children it’s thought that there are hereditary factors involved.

The majority of severe cases of entropion occur in people aged over 60, so as with many eye disorders, age and weakening of muscles and ligaments around the eyes are the main culprits!

There are other causes however, including trachoma bacterial infection under the eyelid, which can at first cause scarring, leading to its inward turning. Trachoma can be contracted when visiting poorer countries having poor hygiene standards and being exposed to the Chlamydia trachomatis bacteria from other people’s eye and nose secretions, or even towels.

Symptoms

Diagnosing a condition of entropion might not be as easy as you would think as the eyelashes may not always touch the eye. It may be that an eye lid is only slightly turned inward and only presents a problem during blinking or sleep.

So symptoms in addition to the obvious one of eye lashes actually touching are:

•    The cornea becoming cloudy and irritated due to abrasion

•    Excessive watery eyes including a discharge

•    “Pink” eye, or redness, associated with pain

What tests are needed for a diagnosis?

No tests are needed really as a thorough inspection by an optometrist or ophthalmologist will be sufficient.

What is the treatment and outcome?

Treatment is initially by way of eye drops to alleviate any pain and discomfort, followed by some form of action to turn the eyelid downwards to keep the eyelashes out of harm’s way

A temporary solution is to simply tape the eyelid down. This can be done at home once some education from the eye practitioner has been received.

An alternative temporary solution involves “Botox” injections in the lower eyelid in such a way that it turns outwards sufficiently. The effects can last up to six months.

After a while of course something permanent needs to be done. The procedure of applying stitches to maintain eyelid positioning can be carried out in a day surgery.

In the case of older patients where the problem has been caused by weakening of muscles, it’s often considered expedient to excise a small bit of the lower lid to tighten everything up – and it works well.

About the Author

Dr Jim Kokkinakis (Optometrist) graduated in 1983 from the Optometry School University of NSW. He is currently a Senior Lecturer there and regular speaker to both Optometrists and Ophthalmologists in Australia and Internationally. He has a specialist clinical practice in the Sydney CBD with interests in Eye Strain, Computer Vision problems, Treatment of Eye Diseases and complex Contact lens Fittings.

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