Entropion is a condition where the eyelid turns inward, causing the eyelashes and skin to rub directly against the surface of the eye. It most commonly affects the lower eyelid and becomes increasingly common with age as the tissues that hold the eyelid in place gradually weaken. Left untreated, the constant friction can damage the cornea and lead to infections, scarring, or vision loss.
Why the Eyelid Turns Inward
Your lower eyelid stays in its correct position thanks to a system of small muscles, connective tissue, and tendons working together. A firm strip of tissue called the tarsal plate gives the lid its structure, while tendons at the inner and outer corners anchor it horizontally. Retractor muscles pull the lid downward and keep it flat against the eye.
When any of these structures weaken, the balance breaks down. In age-related entropion, the most common form, several things happen at once. The tarsal plate loses its rigidity as its collagen fibers degrade and thin out. The retractor muscles loosen or detach from their normal position. And the circular muscle that surrounds the eye (the orbicularis) begins to override the weaker structures beneath it, physically rolling the lid margin inward. Fat behind and around the eye also shrinks with age, removing padding that once helped hold the lid in place.
Types of Entropion
Involutional (Age-Related)
This is by far the most common type, developing gradually in older adults. It results from the combination of horizontal lid laxity, weakened retractor muscles, and the overriding action of the orbicularis muscle. You might notice it comes and goes at first, worsening when you squeeze your eyes shut or blink forcefully, before eventually becoming constant.
Cicatricial (Scarring-Related)
Scarring on the inner surface of the eyelid physically pulls it inward. This can follow chemical or thermal burns, chronic inflammatory conditions, infections, or previous eye surgeries. In many parts of the world, the leading cause of cicatricial entropion is trachoma, a bacterial eye infection. Repeated bouts of trachoma in childhood produce progressive conjunctival scarring that worsens through early adulthood. Research in trachoma-affected regions found that for every year of age under 50, the odds of scarring progression increased by about 3%. Lower socioeconomic status also raised the odds of progression by 29% for each additional marker of poverty, likely reflecting crowded living conditions and limited access to clean water.
Spastic (Acute)
This type appears suddenly, usually triggered by eye irritation, inflammation, or recent surgery. The orbicularis muscle goes into sustained spasm that overwhelms the retractor muscles, flipping the lid inward. It can resolve once the underlying irritation is treated, but it sometimes progresses to a more permanent form if the lid tissues are already lax.
Congenital
Rarely, babies are born with entropion due to structural abnormalities in the eyelid. This is the least common type and sometimes resolves on its own as the child’s face grows.
What It Feels Like
The hallmark sensation is a persistent foreign-body feeling, as if something is stuck in your eye. Because the lashes are physically scraping the cornea with every blink, you may also experience redness and watering that doesn’t improve with drops, a gritty or burning sensation that worsens throughout the day, increased sensitivity to light, blurred vision (especially if the cornea becomes scratched or swollen), and mucous discharge.
Many people instinctively rub or pull at the eyelid for temporary relief. You might notice the symptoms are worse in windy or dry conditions, which makes sense since those environments already stress the corneal surface.
How It’s Diagnosed
An eye doctor can usually spot entropion during a standard examination, but two simple tests help assess how much the lid has loosened. In the distraction test, the doctor gently pulls the lower lid away from the eyeball. A healthy lid won’t move more than 8 mm from the globe. Greater displacement signals excessive laxity. In the snap-back test, the lid is pulled downward and released. A normal lid snaps back into position immediately. A lax lid takes one or more blinks to return to its resting position, or it may not return at all without manual help.
These tests help determine whether the looseness is mild enough for conservative treatment or significant enough to require surgery. The doctor will also examine the cornea for scratches or ulcers using a special dye that highlights areas of damage.
Non-Surgical Treatment
Temporary measures can relieve symptoms while you wait for surgery or if surgery isn’t an option. Taping the lower lid to the cheek keeps the margin from rolling inward. Lubricating drops and ointments protect the cornea from friction damage. Soft contact lenses can also serve as a barrier between the lashes and the eye surface.
For spastic entropion, injections of botulinum toxin into the orbicularis muscle can relax the spasm and allow the lid to return to its normal position. A typical dose for age-related entropion is around 15 units, injected at three sites just below the lash line. The effect lasts several months before the muscle activity gradually returns, so repeat injections may be needed. While effective as a bridge treatment, injections are not considered a permanent fix.
Surgical Repair
Surgery is the definitive treatment for entropion and addresses the specific structural failures causing the problem. For involutional entropion, a commonly performed procedure is the lateral tarsal strip, in which the surgeon tightens the lid by shortening it at the outer corner. The lower portion of the outer canthal tendon is released, a strip of the tarsal plate is isolated, and the shortened lid is anchored to the bone of the orbital rim with sutures. This is typically done under local anesthesia.
Other approaches include everting sutures (sometimes called Quickert sutures), which redirect the lid margin outward by placing stitches through the full thickness of the lid. For cicatricial entropion caused by trachoma scarring, repair is more challenging. Recurrence rates with some techniques run as high as 61%, though more comprehensive multi-step procedures have reported success rates above 90% over follow-up periods averaging about two and a half years.
The choice of technique depends on the type of entropion, how much laxity is present, whether scarring is involved, and whether this is a first repair or a revision of a previous surgery.
Recovery After Surgery
Most entropion repairs are outpatient procedures, meaning you go home the same day. Expect bruising and swelling around the eye for the first week or two. You can shower and bathe normally but should avoid getting soap or shampoo directly in the eye, and it helps to keep the surgical area relatively dry for the first seven days.
For the first two weeks, avoid strenuous exercise, heavy lifting, gardening, swimming, and eye makeup. Hair coloring and perming should also wait. Light activities like reading, watching television, and gentle housework are fine right away. If your job involves physical labor or dusty environments, plan for about a week off work. Most people resume all normal activities within two to four weeks.