Entropion and Ectropion: When Eyelids Turn Inward or Outward

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.

Who should skip private entropion or ectropion repair?

Skip a standard lateral-tarsal-strip if the problem is cicatricial — scar pulling the lid — until the skin disease or previous injury is mapped. Skip if a new facial-nerve palsy is still evolving; the lid may change as the nerve recovers. Skip treating a watering eye as ‘just ectropion’ when the tear duct may also be blocked. Do not delay if the cornea is already scratchy and light-sensitive: lubricant and taping are a bridge, not a cure, while you wait for surgery.

How is involutional repair different from a cosmetic lower blepharoplasty?

Patients often arrive asking for an eye-bag operation when the real problem is a turning lid. Entropion and ectropion repair tighten and reposition the lid margin so lashes and tears behave. Lower blepharoplasty removes or repositions fat and sometimes skin for appearance. Combining them is sometimes right; substituting one for the other is not. If the lashes are on the cornea, that is a functional oculoplastic operation, not an aesthetic add-on.

What can you do while waiting for surgery?

For involutional entropion, taping the lid down and using preservative-free lubricant protects the cornea. Botulinum toxin can temporarily evert a turning-in lid. Neither replaces tightening if the anatomy is lax. For ectropion, ointment on the exposed inner lid reduces drying; tears on the cheek do not mean you have too many tears — they are missing the punctum.

• Lubricant by day and ointment at night until the lid is repaired.
• Do not pluck rubbing lashes as a long-term plan — they grow back stiffer.
• Photograph the lid in the morning: intermittent entropion is easy to miss in clinic if it has temporarily everted.

How is this arranged in Yorkshire with Mr Mohyudin?

He is fellowship-trained in oculoplastics. Private repair is a day case under local anaesthetic at Spire Elland, typically 30–45 minutes per lid. Self-pay starts from £2,000 (practice figure published on the oculoplastics Yorkshire guide, July 2026). NHS funding is usual when the cornea is at risk; private care is for speed or for a named consultant. Call 01422 324000. Huddersfield Royal Infirmary remains the eye-casualty route if the eye is suddenly painful and photophobic.

What matters beyond making the eyelid look straighter?

Explain whether your main difficulty is lashes rubbing, watering, soreness or difficulty closing the eye. The consultation should relate those symptoms to the eyelid position and eye surface. Ask whether a temporary measure is appropriate while you consider treatment and what would make the problem more urgent. Reduced vision or increasing pain should not be left to a routine surgical waiting list.

If repair is recommended, ask which part of the eyelid needs support and what improvement is realistic. Watering may have more than one cause, so restoring lid position does not automatically guarantee a completely dry cheek. Bring details of previous eyelid operations, facial weakness and current drops. The written plan should cover wound care, return to contact lenses and a review of both lid position and eye comfort after swelling settles.

Questions to take to your appointment

• Is the eyelid position causing the symptoms, or is there another contributor?
• How is the eye surface protected while I wait?
• What should I do if pain or vision worsens?