Entropion correction

This leaflet has been produced to provide information for patients requiring surgery to correct an in-turning eyelid.

About entropion

Entropion of the lower eyelid is in-turning of the eyelid margin and rubbing of the eyelashes against the eye. This usually causes irritation, discomfort, redness, excess tearing and mucus discharge. The in-turning lashes could cause significant abrasion of the eye surface if neglected.

What causes entropion?

Most cases of entropion are due to the eyelid tissues becoming loose as a result of ageing. Rarely, the problem is present from birth (congenital), and in some cases it results from scarring of the inner lining of the eyelid, caused by certain skin conditions, infection, chemical burns, thermal burns, or other eyelid trauma.

How is this condition managed?

As a temporary solution, your eyelid skin could be taped to your cheek to keep your lashes away from the surface of your eye. Lubricant drops and/or ointment also help to relieve discomfort. However, surgery is required for a definitive solution. The aim of surgery is to restore your eyelid to its normal position, protect the ocular surface from damage and improve the comfort of your eye.

About surgery

What does the surgery involve?

Entropion surgery is usually performed under local anaesthesia as a day case, but a general anaesthetic is possible if you prefer. In most cases, your eyelid is tightened and rotated into the normal anatomical position with some fine stitches. Rarely, the inner lining of your eyelid may need to be enhanced with a graft. The local anaesthetic injection is a little uncomfortable, but the operation is not painful and generally lasts about 45 minutes.

Post-operative care

A pressure dressing is usually applied to the operated eye to reduce swelling and bruising. If both lower lids are operated on simultaneously, one eye may be covered, but you will need to apply ice packs to the uncovered eye to stop it swelling. You will usually be able to remove the pressure dressing at home on the first post-operative day, but it may have to remain undisturbed for a minimum of 48 hours if a skin graft is used. Once you have removed the dressing, you can clean the wound carefully with some cooled boiled water and cotton wool balls or cotton gauze. You can shower normally, but pat the wound carefully dry. Antibiotic drops or ointment will be prescribed for the operated eye(s) for a fortnight. You will normally be reviewed in outpatients within two to three weeks after the surgery. You can return to work or resume normal activities within a few days, but it is best to avoid swimming for a fortnight. Whilst your eyelid is healing, your eye may feel a little gritty and tender at the outer corner. The stitches are usually self-dissolving, but may be removed at your first post-operative visit.

What are the risks/ side effects of entropion surgery?

• Swelling and bruising of your eyelid is common, variable and usually resolves in 10 to 14 days.
• Excessive bleeding is usually due to blood-thinning tablets such as aspirin, clopidogrel or warfarin. You may have to stop taking these before surgery but only if your surgeon advises and your GP approves.
• Bruising of eye may occur.
• Infection of the eyelid or eye socket happens rarely.
• The entropion may occasionally recur, or your eyelid may be turned too far outwards (overcorrection), requiring further surgery.
• Allergic reaction to the local anaesthetic or antibiotics drops/ ointment is rare.
• The scar from the surgery usually blends into the natural skin crease and is barely visible in most cases, but may be noticeable. Some patients scar more readily than others.
• If a tissue graft it used, the graft may not take, especially if there is infection.
• Rarely, a tender lump, called a granuloma, forms in relation to your eyelid wound. This usually resolves spontaneously but may need to be surgically excised if it persists.

Medication

Please bring a list of all of your medicines or a current repeat prescription from your GP.

You will be given some antibiotic ointment with advice on how to apply it to the operated eye(s) and wound(s) for two weeks after the operation. You may need to use paracetamol for a few days after the operation if your eye or wound is uncomfortable.

Contacts/ Further information

Please contact the theatre bookings team in the Eye Department on 01223 274863 if you have any queries regarding your appointment for surgery. For urgent post-operative concerns, please contact the Emergency Eye Service on 01223 217778.