Entropion
The CMGs are guidelines on the diagnosis and management of a range of common and rare, but important, eye conditions that present with varying frequency in primary and first contact care.
The CMGs are guidelines on the diagnosis and management of a range of common and rare, but important, eye conditions that present with varying frequency in primary and first contact care.
Inward rotation of the tarsus and lid margin, causing the lashes to come into contact with the ocular surface
Most cases have a single aetiology but some are multi-factorial
Age-related degenerative changes in the lid
Severe cicatrising disease affecting the tarsal conjunctiva
Ocular irritation or previous surgery
Foreign body sensation, irritation
Red, watery eye
Blurring of vision
Corneal and/or conjunctival epithelial disturbance from abrasion by the lashes (wide range of severity)
Localised conjunctival hyperaemia
Lid laxity (involutional entropion)
Conjunctival scarring (cicatricial entropion)
Absence of lower lid crease (congenital entropion)
Distraction test
Snap-back test
Eyelid retraction (e.g. Graves’ disease):
Distichiasis:
Trichiasis:
Dermatochalasis:
Epiblepharon:
Practitioners should recognise their limitations and where necessary seek further advice or refer the patient elsewhere
GRADE* Level of evidence and strength of recommendation always relates to the statement(s) immediately above
Taping the lid to the skin of the cheek, so as to pull it away from the globe, can give temporary relief (particularly for involutional or spastic entropion)
Epilation of lashes can be done where the trichiasis is localised (eg in cicatricial entropion)
(GRADE*: Level of evidence=low, Strength of recommendation=strong)
Therapeutic contact lens to protect cornea from lashes
(GRADE*: Level of evidence=low, Strength of recommendation=weak)
Ocular lubricants for tear deficiency/instability related symptoms (drops for use during the day, unmedicated ointment for use at bedtime)
NB Patients on long-term medication may develop sensitivity reactions which may be to active ingredients or to preservative systems (see Clinical Management Guideline on Conjunctivitis Medicamentosa). They should be switched to unpreserved preparations
(GRADE*: Level of evidence=low, Strength of recommendation=strong)
B1: Initial management (including drugs) followed by routine referral
Congenital entropion does not resolve spontaneously and the potential for severe corneal complications requires referral for prompt treatment
The choice of surgical procedure depends on the underlying cause(s)
Surgical intervention is indicated if any of the following are persistent:
There is evidence that the combination of horizontal and vertical eyelid tightening is an effective treatment for entropion
*GRADE: Grading of Recommendations Assessment, Development and Evaluation (www.gradeworkinggroup.org)
Sources of evidence
Boboridis KG, Bunce C. Interventions for involutional lower lid entropion. Cochrane Database Syst Rev. 2011;(12):CD002221
Hintschich C. Correction of entropion and ectropion. Dev Ophthalmol. 2008;41:85-102
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).
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.
Entropion
Version 6
Date of search 20.05.17
Date of revision 20.09.17
Date of publication 05.12.17
Date for review 19.05.19
© College of Optometrists
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