AKT · Ophthalmology/Lids & surface

Entropion

In-turning of the eyelid margin → lashes abrade the cornea (involutional)

Overview

Inward turning of the (usually lower) eyelid margin so the lashes rub the cornea/conjunctiva (trichiasis), causing pain, foreign-body sensation and a risk of corneal abrasion/ulcer. Usually involutional; cicatricial forms follow scarring (e.g. trachoma).

Recognise

Lid margin turned inward; lashes contacting and abrading the globe
Foreign-body sensation, pain, redness, watering, photophobia
Corneal abrasion/ulcer risk from chronic lash trauma

Red flags

Corneal ulcer (pain, white infiltrate, photophobia, reduced vision) from lash abrasion → same-day ophthalmology

Differentials & how to tell them apart

Ectropionlid turns OUTWARD with epiphora — opposite

Trichiasismisdirected lashes with a normally positioned lid margin

Cicatricial entropion (trachoma)conjunctival scarring (Arlt line) pulling the lid in — endemic-area history

Investigations

Clinical; fluorescein to detect corneal abrasion from the lashes.

Management

Tape/lubricate + refer for surgical correction (lashes are abrading the cornea)

1Lubricate and tape the lid outward to protect the cornea; epilate offending lashes as a temporary measure.Gate: Same-day ophthalmology if a corneal ulcer/abrasion is present — chronic lash abrasion threatens sight
2Definitive: oculoplastic surgery (e.g. everting sutures, lid-tightening). Treat cicatricial causes.

Lubricants + taping the lid out — temporises and protects the cornea

Botulinum toxin — temporary correction of spastic entropion

Key points

Lashes in = entropion = corneal abrasion risk. Always fluorescein the cornea.

Monitor & prognosis

Corneal integrity.

Good with surgery.

Source: College of Optometrists CMG; RCOphth