Entropion and ectropion are among the most common eyelid conditions managed by oculoplastics surgeons. They predominantly affect the lower eyelid in older adults, as the horizontal eyelid laxity that comes with ageing allows the lid to rotate inward or sag outward. Both are surgically correctable, and the procedures are well tolerated.
Entropion — eyelid turning inward
In entropion, the eyelid margin (and with it the lashes) rotates inward so that the lashes constantly rub against the surface of the eye. This causes continuous foreign body sensation, watering, redness, and if left untreated, corneal scarring.
The most common cause in the UK is involutional entropion — age-related horizontal and vertical laxity of the lower eyelid. Less common causes include scarring from previous surgery, trauma, or conditions such as trachoma.
- Symptoms: constant grittiness or feeling of something in the eye, excessive watering, redness, light sensitivity.
- On examination: the lower eyelid margin is turned inward; lashes may be pressing against the cornea.
- Complications of untreated entropion: corneal abrasion, corneal ulcer, corneal scarring affecting vision.
Ectropion — eyelid turning outward
In ectropion, the lower eyelid sags and rolls outward away from the eye. The inner surface of the eyelid (conjunctiva) becomes exposed and chronically inflamed. Tears drain poorly and overflow down the cheek (epiphora). The exposed conjunctiva may become thickened and irritated (conjunctival hypertrophy).
Causes are similar to entropion: involutional (age-related) laxity is most common. Cicatricial (scar-related) ectropion occurs after eyelid injuries or skin conditions such as eczema or rosacea.
- Symptoms: watering eye (tears running down the cheek), sticky discharge, redness of the lid margin, soreness.
- On examination: lower eyelid margin pulled away from the eye, exposed conjunctiva.
- Complications: chronic conjunctivitis, corneal drying, exposure keratopathy.
Surgical treatment
Both entropion and ectropion repair are performed as day-case procedures under local anaesthetic. The fundamental principle for involutional cases is tightening the horizontal laxity of the lower eyelid — usually by a lateral tarsal strip procedure (LTS) or similar.
For entropion, the retractors of the lower eyelid may also be reattached or plicated to prevent the inward rotation. For ectropion with excess skin or cicatricial changes, a small skin graft may be needed.
- Operation time: 30–45 minutes per eyelid.
- Anaesthetic: local anaesthetic. You are awake but comfortable.
- Recovery: bruising and swelling for 1–2 weeks. Sutures removed at 7–10 days.
- Success rate: high — the vast majority of involutional cases are resolved after a single procedure.
NHS and private options
Both entropion and ectropion are funded by the NHS when causing corneal complications or significant symptoms, as they are functional eyelid conditions. Private treatment is available for those wishing to avoid NHS waiting times.
Frequently Asked Questions
Can entropion or ectropion be treated without surgery?
Temporary measures exist — taping the eyelid, lubricating drops for corneal protection, and botulinum toxin (Botox) injections to temporarily evert an entropion. However, these are temporary measures only. For definitive, lasting correction of involutional entropion or ectropion, surgical tightening of the lower lid is the appropriate treatment.
Is entropion or ectropion surgery painful?
The procedures are performed under local anaesthetic. The injections to numb the eyelid are mildly uncomfortable for a few seconds; the operation itself is painless. Most patients report mild soreness and aching in the first 24–48 hours, well managed with paracetamol.
Mr Mohamed Mohyudin
MBChB BSc MSc FRCOphth CCT — Consultant Ophthalmic Surgeon, Spire Elland Hospital, Yorkshire. GMC 7039600.
View full credentials →