Lower Eyelid Entropion

Lower eyelid entropion is an eyelid malposition in which the lower eyelid margin is turned inwards against the globe causing discomfort from contact between the eyelashes and the surface of the eye. An entropion is usually involutional (age-related) and the majority are therefore seen in older patients.

Management
In the case of acute spastic entropion, the treatment is directed to the provoking stimulus e.g. in growing eyelashes, blepharitis, dry eye. Although a bandage contact lens or botulinum toxin injections may improve symptoms temporarily, these are rarely justified. The use of lower lid tape can be advised for use in primary care while the patient is waiting to be seen by an ophthalmologist.

Surgical Management
These procedures are commonly used to manage this eyelid problem:

• Everting sutures
• Lower lid retractor advancement with lateral tarsal strip

These procedures are usually performed under local anaesthesia with or without mild sedation. Everting sutures are offered to all older patients at the initial consultation and are used exclusively for the following patients:

• • Elderly patients with concomitant medical problems for whom surgery is contraindicated
• • Patients with a severe bleeding tendency e.g. patients taking warfarin
• • Patients unable to co-operate with surgery
• • Patients who are unable to lie in a semi-recumbent position e.g. due to breathing difficulties

Everting sutures have been commonly regarded as a temporary form of treatment but many patients achieve a permanent result with the sutures alone. If the entropion recurs they are offered a repeat procedure or a more definitive surgical procedure. The sutures are very quick and simple to insert in a clinic setting and provide instant relief for the patient.

For all other patients, a lower eyelid retractor advancement combined with a lateral tarsal strip procedure is performed in the operating theatre. This is a very convenient operation for the patient as no sutures need to be removed. It does, however, leave a sore tender lumpy area at the outer corner of the lower eyelid for a few weeks before this settles.

Consultants who undertake this procedure:

Saj Ataullah
Anne Cook
Brian Leatherbarrow
Ahmed Sadiq