Are Your Eyelashes Turned Inward or Outward?
The eyelids are important for protecting the eyes from damage, debris and dryness. When the eyelids are not positioned properly, this can cause discomfort and harm to the front of the eye. Two main types of eyelid positional issues exist and are classified as entropion, inward turning of the eyelids, and ectropion, outward turning of the eyelids.
Entropion (Eyelashes Turned In)
This eye condition is defined as an inward turning of the eyelid margin towards the eyeball. It more often affects the lower eyelid and can be in only one eye or both eyes.
Symptoms of this condition include increased tearing and the sensation of something being stuck in the eye. The eyes may also show signs of a rolled in eyelid, redness, and inwardly turned eyelashes. This can ultimately cause scarring of the front surface of the eye.
One of the main causes of entropion is due to age-related changes. This is because of the breakdown of the eyelid tissues with age. Another cause is being born with it, due to abnormal development of the eyelid and its musculature.
Cicatricial entropion refers to scarring of the eyelid that causes the eyelid margin to be pulled towards the eyeball. This scarring could be due to trauma, chemical injuries, infections like trachoma, or inflammatory conditions such as Stevens-Johnson syndrome.
Treatment could be temporary or permanent. Temporary treatment options include artificial tears or ointments to protect the front surface of the eye and prophylactic antibiotics to limit secondary infections. A bandage contact lens can also be used to prevent damage to the eye.
Removal of inward turned eyelashes is another temporary fix, as these lashes can grow back. Long term solutions like eyelid surgery aim to bring the eyelid back out and tighten the musculature. The most important treatment of all is to identify the underlying cause if possible and manage that initially.
Ectropion (Eyelashes Turned Out)
An outward turning of the eyelid margin is referred to as ectropion. This is also seen more often in the lower eyelid and is very common in elderly patients.
Symptoms for this condition are similar to entropion in that the patient will have an increase in tearing as well as a feeling of something being in the eye. The eyelid will show signs of a lid that is turned outwards and a red eye.
The most common cause is due to age-related changes. It is a natural change that occurs due to an increase in eyelid laxity and the lid being pulled down by gravity.
Another cause is referred to as mechanical ectropion and occurs due to a mechanical force pulling on the eyelid. This could be a tumor or a large bump on the eye.
Cicatricial ectropion is similar to the entropionic form in that it is due to scarring of the skin around the eyes, although, this time, it is causing the eyelid to be pulled away from the eyeball.
Causes include trauma, burns, chemical injuries and radiotherapy. Paralytic ectropion is the last subtype and is due to neurological damage to the facial nerve. This causes a decrease in the muscle tone of the muscle surrounding the eye and causes the eyelid to droop down. Bell’s palsy is an example of an associated condition for paralytic ectropion.
Similar to entropion, ectropion has both temporary and long term treatment options. Artificial tears and ointments are a temporary method to protect the eye from dryness.
Taping the eyelids closed at night also prevents dryness. Botox injections and temporary suturing of the eyelids together can help with the laxity in the eyelids. Long term solutions include surgery to reconstruct the eyelids.
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