The CMGs offer information on the diagnosis and management of a range of conditions that present with varying frequency in primary and first contact care.
Entropion is the inward rotation of the tarsus and lid margin so that the lashes come into contact with the ocular surface. It is most commonly caused by loss of eyelid elasticity and muscle tone as part of the ageing process. Prevalence is approximately 2% in the over 60s and 11% in those aged over 80. This Clinical Management Guideline outlines the aetiology, signs and symptoms and evidence-based recommendations for diagnosing and treating entropion. It provides recommendations for non-pharmacological management and pharmacological treatment, and outlines when either routine or urgent referral may be appropriate.
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What is entropion?
Entropion is a condition in which the edge of the eyelid (usually the lower lid) rolls inwards, so that the eyelashes touch the surface of the eye. The commonest cause is loss of elasticity and muscle tone of the eyelids which happens as part of the ageing process. It can also result if the eyelid is scarred following inflammation or injury. In many countries of the world entropion occurs as a complication of repeated infection by the trachoma agent (Chlamydia trachomatis).
How is entropion managed?
The affected eye becomes irritable, red and watery, and vision may be blurred. The optometrist will be able to see the effect of eyelashes rubbing on the eye surface and may be able to determine the cause. Taping the edge of the eyelid to the skin of the cheek may give temporary relief, as may the removal of lashes or the fitting of a bandage contact lens to protect the eye surface from contact with the eyelashes. Patients may be helped by artificial tears and unmedicated ointments. These measures will not cure the condition, so patients are often referred routinely to the ophthalmologist for consideration of surgery, usually under local anaesthetic, which may solve the problem.