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Observations on the Etiology of Involutional Entropion.

Philip L Custer¹

¹John F. Hardesty, MD, Department of Ophthalmology and Visual Sciences, Washington University School of Medicine, St. Louis, Missouri, U.S.A.

Ophthalmic Plastic and Reconstructive Surgery

|December 19, 2024

Summary

Involutional entropion is caused by age-related eyelid changes like retractor dehiscence and laxity. Understanding these anatomic factors is key for effective surgical repair.

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Area of Science:

Ophthalmology
Oculoplastics
Anatomy

Background:

Involutional entropion is a common condition in older adults.
It results from age-related anatomical changes in the eyelid.
Identifying these changes is crucial for surgical planning.

Purpose of the Study:

To review existing evidence on the anatomical causes of involutional entropion.
To propose additional potential contributing factors to the condition.

Main Methods:

A comprehensive literature review was conducted.
Publications detailing possible etiologies of involutional entropion were identified.
Author's clinical observations and new proposed causes were included.

Main Results:

The most frequent causes identified were retractor dehiscence (97%), horizontal eyelid laxity (89%), and orbicularis override (89%).
Other contributing factors include enophthalmos (33%), tarsal atrophy (16%), and fat prolapse (10%).
Eyelid distraction tests often reveal horizontal margin laxity, with poor deep fixation and increased inferior mobility of the lateral canthus.

Conclusions:

Age-related anatomical changes predispose individuals to involutional entropion.
Lower eyelid retractor dehiscence and tarsal atrophy are significant factors.
Individualized surgical repair considering all anatomical findings is recommended.