Eyelid Turns In or Out (Ectropion or Entropion)

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KEY POINTS

• Ectropion happens when your child’s eyelid, usually the lower eyelid, turns out away from the eye. This can lead to drying of the front of the eye, and may increase the risk for an infection.
• Entropion happens when your child’s eyelid, usually the lower eyelid, rolls in towards the eye. The edge of the eyelid and eyelashes can rub against the surface of your child’s eye and irritate it and lead to scarring of the surface of the eye.
• Treatment may include artificial tear drops and ointment, eyelash removal, medicine, or surgery.

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What is ectropion or entropion?

Normally the upper and lower eyelids rest comfortably against the surface of your child’s eye. They help to protect the surface of your child’s eye and keep it moist and lubricated with tears.

Ectropion happens when your child’s eyelid (usually the lower eyelid) turns out away from your child’s eye. This can lead to drying of the front of your child’s eye, and may increase the risk for an infection.

Entropion happens when your child’s eyelid (usually the lower eyelid) rolls in towards your child’s eye. The edge of your child’s eyelid and the eyelashes can rub against the surface of your child’s eye and irritate it. If not treated, entropion can lead to long-term tearing problems and scarring of the surface of your child’s eye.

What is the cause?

Problems with your child’s eyelids turning in or out may be caused by:

• A problem that your child is born with
• Scar tissue that forms after an injury, surgery, sun damage, or skin cancer
• Loss of muscle tone from damage to the nerves that control the muscles in your child’s face and eyelids
• Eyelid spasms, swelling or irritation of your child’s eye

What are the symptoms?

Symptoms may include:

• Dry, red eyes that feel scratchy
• Watery eyes
• Gritty feeling or sharp pain in your child’s eyes
• Decreased vision or blurry vision

How is it diagnosed?

Your eye care provider will ask about your child’s symptoms and medical history and do exams and tests such as an exam using a microscope with a light attached, called a slit lamp, to look closely at the front and back of your child’s eye. Your provider may also take photographs to document the appearance of your child’s eyelids and to help in your child’s follow up care

How is it treated?

For mild problems, artificial tear drops and ointment may keep your child’s eye comfortable.

Special skin tape can help pull the edge of your child’s lid and eyelashes away from the surface of your child’s eye. This makes your child’s eye feel better, but does not correct the problem.

Your child’s healthcare provider may also recommend the removal of several eyelashes to prevent them from irritating the eye. This can be done with special tweezers, heat treatment or laser treatment.

If the problem is caused by a spasm, a very small amount of a medicine called botulinum toxin A can be injected into the muscles that close your child’s eyelids. This may weaken or stop the muscle spasms for several months. The shots need to be repeated to keep spasms under control.

Your child’s healthcare provider may recommend surgery to tighten your child’s eyelid. This may be done with or without a skin graft, often using a small piece of extra skin from your child’s upper eyelid.

How can I take care of my child?

Follow the full course of treatment your healthcare provider prescribes. Ask your healthcare provider:

• How and when you will get your child’s test results
• How long it will take to recover
• If there are activities your child should avoid and when he can return to his normal activities
• How to take care of your child at home
• What symptoms or problems you should watch for and what to do if your child has them

Make sure you know when your child should come back for a checkup. Keep all appointments for provider visits or tests.

How can I prevent eyelid problems?

Eyelid problems usually cannot be prevented. However, regular eye exams will allow your child’s eye care provider to start treatment earlier.