Ectropion and Entropion are two different yet similar conditions that can make the eye deviate from its perfect function as the window to the soul. These two disorders are common and they affect about 2.1% of people above the age of 60 worldwide. The good news is, there are treatment for both conditions but how do you know the difference? Let’s break it down. Please pay attention to the first two letters in each spelling, they make the difference in pronunciation.
What is Ectropion and Entropion?
Ectropion is when the lower eyelids turn outwards (everted) exposing the surface of the eye. This causes the eyelid margins not to touch the eyeball surfaces smoothly. When ectropion happens, the two eyelids cannot meet properly, and tears are not spread over the eyeball. Also, the tear duct can turn away from the tear lake as the lid loosens, leading to excess tearing (epiphora).
Entropion is when the lower eyelids turn inwards (inverted) causing the eyelashes to rub against the surface of the eyeball. Note that, the eyelid margins naturally have to touch the surface of the eyeball so it can smoothly move over it when we close it to lubricate it. We do not want the eyelashes touching the eyeball surface. This can lead to severe ocular surface irritation, corneal ulcer, and scarring, which can further lead to vision loss.
In most cases, both conditions affect the lower eyelids but can affect the upper lids in rare cases.
Difference between Ectropion and Entropion.
These two conditions share more similarities than differences. The causes, symptoms, and treatments are similar in both conditions. The key difference between the two is the way of presentation: In ectropion, eyelids turn outward and in Entropion, the eyelids turn inward.
Causes of Ectropion and Entropion
Aging: The principal cause of ectropion and entropion is aging. As we age, the tissues holding the lower eyelids in place begin to loosen (laxity). This then causes the eyelids to turn in or out.
Scar Tissue: A scar tissue in/on the eyelids can contract to pull the eyelids in/out respectively. This is called Cicatricial entropion or ectropion.
Trauma and Injuries: A trauma or an injury to the eyelids can cause it to turn in or out.
Rubbing of Eyelids: Intense rubbing of the eye can lead to these two conditions by loosening the skin tissues around the eye.
Surgery: Ectropion and Entropion can result from surgical procedures involving the eyelids or even facial surgery.
Facial Nerve Palsy: This can cause decreased orbicularis muscle tone. The orbicularis muscle supports the eyelids to open or close, if there is a weak or absent tone, it can easily lead to paralytic ectropion.
Congenital: Though rare, some people are born with ectropion or entropion.
Signs and Symptoms of Ectropion and Entropion
Patients suffering from Ectropion and Entropion can experience the following:
- Foreign Body sensation in the eye.
- Eye Redness and Pains
- Sagging skin around the eye
- Excessive tearing (watering)
- Blurry vision
- Itching
- Sensitivity to light and wind
- Discharge or crusting on lids
Treatment Options
While medical management can bring some relief, it is mostly temporally or has to be done repeatedly. The definitive solution is Surgery.
Surgery: This is the effective treatment to ectropion and entropion. Even with surgery recurrence does occur occasionally after several years requiring a repeat surgery. There are a couple of surgeries that can be done.
- Eyelid tightening: This procedure shortens your eyelid (called a lateral tarsal strip) to tighten your lid.
- Retractor reinsertion: This procedure is used to tighten your lid retractor (the muscle that opens and closes your lid).
For medical interventions, the following can provide some level of relief:
Lubricating Eyedrops: Artificial tears can be applied to keep your eyes moist and relieve you of some symptoms such as dry eye syndrome and foreign body sensation.
Tape or Stitches: This is another temporal fix. In this case, your doctor may use tape to reposition your eyelids into a more favorable position after applying local anesthetics to numb the eyelids.
Botox: A small amount of a substance called botulinum toxin can be used to weaken your eyelid muscles that are causing your lid to turn in. This may be used every three to four months if surgery isn’t an option.
Contact Lens: Bandage contact lens can also be used to relieve irritation or trichiasis.
