Browse the corpus

Entropion is an inversion of the eyelid margin and is an extremely common lid malposition. Often the eyelashes are directed posteriorly at the globe. When the eyelashes are directed toward the globe, corneal and conjunctival damage can ensue, potentially leading to corneal disease. Surgical repair of entropion is performed to restore the eyelid to its proper anatomical alignment. This, in turn, protects the eye from injury and reduces associated symptoms. This activity describes the four types of entropion: congenital, involutional, acute spastic, and cicatricial. This activity also reviews the evaluation and treatment of entropion and discusses the role of the interprofessional team in evaluating and treating patients with this condition. Objectives: Differentiate the 4 types of entropion by etiology and underlying risk factors. Identify appropriate indications for entropion repair and manage postoperative complications. Compare the various approaches for surgical correction of entropion and the risks and benefits of each. Implement efficient and effective interprofessional practices for the management of entropion in the prehospital, hospital, and postoperative settings. Access free multiple choice questions on this topic.

Entropion is an inversion of the eyelid margin, wherein the margin is abnormally rotated towards the globe. This malposition is extremely common and disrupts the normal tear film and protective functions of the eyelid. This malposition often directs the eyelashes posteriorly at the globe, which can cause corneal and conjunctival damage, potentially leading to chronic corneal disease. Entropion can be unilateral or bilateral, involving either the upper or lower eyelids. There are four types of entropion: congenital, involutional, acute spastic, and cicatricial. The most common cause of entropion of the lower eyelid is involutional, while in the upper eyelid it is cicatricial.[1][2][3] The risk of developing entropion increases with increasing age. This is particularly true for involutional entropion, which occurs secondary to age-related weakening and laxity of the muscles and tendons.[4] As we age, the canthal tendons relax, and the eyelid retractors attenuate, causing malposition of the eyelid margin. Infection, irritation, and inflammation are the primary causes of acute spastic entropion. This condition occurs most commonly after intraocular surgery in patients with unrecognized preoperative involutional eyelid changes. Continual orbicularis oculi muscle contraction causes inward rotation of the eyelid margin. This, in turn, causes corneal irritation due to lash rub, which perpetuates the problem. Cicatricial entropion is caused by a tarsoconjunctival contracture. Any mechanism that results in increased scar tissue formation, especially in the inner and middle layers of the eyelid, can put an individual at risk for developing cicatricial entropion. Some common risk factors include prior burns, infection, inflammation, connective tissue disease, and trauma, including transconjunctival surgery.[5][6]

Complications of entropion repair include hemorrhage, undercorrection or overcorrection, lower lid retraction, infection, wound dehiscence, scarring, corneal injury, milphosis, and eyelid margin necrosis.[13][14][15]

Patients with entropion may first present to the advanced practice or primary care provider. Since entropion is a progressive disorder with the potential to cause injury to the cornea, it is important to refer these patients to an oculoplastic surgeon or an ophthalmologist. Several techniques exist for repairing entropion, and skill and experience are required. Operating room and ophthalmology nurses assist in care and provide patient education. The outcomes for most patients are good, but some patients require revision, and cosmesis is not always perfect.[16][17]

Preoperative visual acuity should be noted in both the affected and unaffected eye as a baseline. Any acute change in visual acuity preoperatively should prompt further evaluation, as this would not be expected from simple lid malposition, and may reflect corneal or other ocular pathology. Formal optometric examination may also be of benefit, particularly if the patient has known additional ocular pathology, such as glaucoma.

Postoperative nursing education includes application of ophthalmic ointment twice daily to the eye until seen again in clinic. The patient should be instructed to keep the eye clean and dry and to use artificial tears daily. Patients should avoid manipulating the eyelids and should refrain from wearing contact lenses until cleared to do so by their surgeon.