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Entropion and Ectropion: Eyelid Turned In or Out (People, Dogs and Cats)
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Entropion is an eyelid that turns inwards, so the lashes and the lid edge rub against the eye. Ectropion is an eyelid that turns outwards, so the lid sags away from the eye. Both mostly affect the lower lid in older adults, can harm the cornea if left alone, and are corrected with minor eyelid surgery, the field of Prof. Dr. Ahmet Satıcı at Laser Istanbul Clinic. People who search "entropion dog" are asking about the same fault in pets: it is common in dogs, and only a vet can treat it.
Entropion and ectropion: key facts
- Entropion
- The margin of the upper or lower eyelid turns inwards against the surface of the eye
- Ectropion
- The lower eyelid turns outwards and droops away from the eye
- Most common cause
- Ageing: loosening of the muscles, tendons and tissue that hold the lid in place (involutional change)
- Typical symptoms
- Entropion: irritation, a gritty or foreign-body feeling, watering, redness. Ectropion: watering (the most common symptom), red sore eyes, dryness, sometimes repeated conjunctivitis
- Main risk
- Entropion: lashes scratching the cornea (abrasion, ulcer). Ectropion: an exposed, dry eye; rarely, corneal infection
- Usual treatment
- Surgery to reposition the lid, usually under local anaesthetic as a day case; mild ectropion may only need lubricating drops or ointment
- Specialist
- Oculoplastic (eyelid) surgeon; at Laser Istanbul Clinic, Prof. Dr. Ahmet Satıcı
- In pets
- Entropion is the most frequent inherited eyelid defect in many dog breeds and also affects cats; it needs a vet
What is the difference between entropion and ectropion?
The two terms are opposites. In entropion the lid edge rolls in, so the lashes and lid margin touch the eye. In ectropion the lid edge rolls out, so the inner surface of the lid is exposed and the lid no longer hugs the eye.
| Entropion | Ectropion | |
|---|---|---|
| Direction | Lid turns inwards | Lid turns outwards |
| Usual lid | Lower (the upper can be affected, mainly from scarring) | Lower |
| What hurts the eye | Lashes and lid edge rubbing the cornea | Dryness from poor lid closure; tears that cannot drain |
| Leading symptom | Irritation, a gritty feeling, watering | Watering, redness, dryness |
| Most common cause in adults | Age-related lid instability | Age-related laxity of the lid and its tendons |
| Other causes | Scarring from injury, chemical burns, inflammation or infection (trachoma), eyelid spasm | Facial palsy, scarring, skin disease, lid lumps, previous surgery |
A related but different problem is trichiasis: lashes that grow towards the eye while the lid edge itself sits in a normal position. In entropion the whole lid margin is rolled inwards, and the two conditions need different treatment.
What causes entropion?
Entropion causes fall into four groups.
| Type | What happens | Typical patient |
|---|---|---|
| Involutional (age-related) | With age the lid loosens: the tendons that anchor the lower lid stretch, the retractors that pull the lid down weaken, and the muscle ring around the eye (orbicularis) slides upwards over the lid's firm plate and rolls the edge inwards. It is the most common type | Older adults; one study of 155 people had an average age of 75 (range 56–93) |
| Cicatricial (scarring) | Scar tissue on the inner surface of the lid pulls the edge inwards. Causes include trachoma, an autoimmune skin disease (mucous membrane pemphigoid), chemical burns, injury and previous surgery | Any age; upper-lid entropion is mainly this type |
| Spastic (spasmodic) | A muscle spasm around the eye turns the lid in; irritation causes more squeezing, which makes it worse | Often seen in older adults, or people with eyelid spasm (blepharospasm) |
| Congenital | Present from birth, mostly in the lower lid; skin and muscle folds push the lashes against the eye | Babies and children; it tends to correct itself with age, so mild cases are usually watched |
Three things combine in the age-related type: horizontal laxity of the lid, weakness or detachment of the lower lid retractors, and the muscle override described above. Good surgery has to correct each of them, which is why several techniques are often combined.
Trachoma, a bacterial eye infection and the leading infectious cause of blindness worldwide, is a classic cause of scarring entropion: after years of repeated infection the lid scars and turns in, and the lashes scrape the eye. The World Health Organization reports that 92 million people live in trachoma-endemic areas (March 2026), and that in 2025 about 98,800 people received surgery for advanced disease.
What causes ectropion?
Ectropion is mostly a problem of age as well. The NHS and the British Oculoplastic Surgery Society (BOPSS) list these causes:
- Age-related laxity of the tissues, muscles and tendons around the eye: the most common cause
- Facial nerve palsy, such as Bell's palsy, which weakens the muscle that holds the lid up
- Scarring from injury, burns, shingles or previous surgery pulling the lid down
- Skin disease, such as allergic dermatitis
- Lid lumps, cysts or tumours that pull on or weigh down the lid
- Long-term use of some eye drops (named by the NHS as a less common cause)
Doctors describe four acquired types: involutional, cicatricial (scarring), paralytic (nerve) and mechanical (a lump or weight pulling the lid down). Surgery near the eyelids can occasionally leave a lid out of position, too, which is one reason to choose an experienced eyelid surgeon.
Entropion and ectropion symptoms: what you notice in the eye
Entropion eye symptoms come from the lid edge and lashes rubbing the eye. Irritation is the commonest: in one study of 155 patients with age-related entropion, 94% presented with eye irritation, 12% with tearing and 11% with redness. In full, watch for:
- a gritty, scratchy or foreign-body feeling
- watering and redness
- soreness, and worse irritation when you blink or squeeze the eye (which can turn the lid in further)
- if the cornea is scratched or ulcerated: blurred vision, more pain, light sensitivity and heavy watering
Ectropion symptoms come from poor lid closure and poor tear drainage:
- watery eyes, the most common symptom, because the tear drainage opening (punctum) no longer touches the eye
- red, sore, irritated eyes and a dry, gritty feeling
- difficulty closing the eye fully
- recurrent conjunctivitis
- a visibly drooping, sagging lower lid that shows its red inner lining
Ectropion can make an eye water and feel dry at the same time: the surface is exposed and irritated, while tears run away instead of draining. A watery eye is not always a well-lubricated one.
Can entropion or ectropion damage your sight?
Yes, if left, though most cases do not reach that stage. BOPSS states that untreated upper-lid entropion in particular puts the cornea at risk, causing abrasions and ulcers. A corneal ulcer is an emergency (see "When to see a doctor"). In the 155-patient study above, one eye (0.5%) suffered corneal perforation from a severe ulcer, a rare but serious outcome. For ectropion, BOPSS says that, rarely, untreated ectropion can lead to corneal exposure and corneal infection that put vision at risk.
This is why a lid that turns in or out, with an eye that has been sore for weeks, should not be ignored however mild it seems.
How are entropion and ectropion diagnosed?
Diagnosis is clinical (the MSD Manual's term): an eye doctor can usually see the problem by looking at the lids, and checks the cornea for damage, typically with a slit lamp (a bright microscope). Two bedside tests show how loose the lower lid is:
- Snap-back test: the lower lid is pulled down and let go. A healthy lid springs back to the eye straight away; any delay means the lid is slack.
- Distraction test: the lid is pulled away from the eye. In one clinical study the normal distance was 7–8 mm or less, and more than that counted as laxity.
The doctor also asks about previous injury, surgery, skin disease, facial weakness and eye drops, because a cause such as scarring or nerve palsy changes the treatment.
Entropion treatment and ectropion treatment
| Treatment | What it does | Used for |
|---|---|---|
| Lubricating drops and ointment | Protect a dry, exposed eye | Mild ectropion; symptom control (NHS, MSD Manual) |
| Taping the lids closed | Protects the cornea | Mild ectropion (NHS) |
| Botulinum toxin (BoNT/A) injection | Relaxes the overactive muscle; the paralysis is transient, so injections are repeated | Spastic entropion, studied in elderly patients who refused or were declined for surgery |
| Treating the underlying cause | For example controlling infection or inflammation | Scarring and other secondary types (MSD Manual) |
| Surgery to reposition the lid | Corrects the cause of the malposition | Established entropion and ectropion, and any case that threatens the cornea |
Entropion surgery: how it is done
Entropion surgery repositions the lid margin and lashes away from the eye. According to BOPSS, it is usually an outpatient (day-case) operation under local anaesthetic (sedation optional in complex cases) lasting about 45 minutes. The surgeon works through incisions in the natural skin crease, adjusts the muscle and repositions the lid with absorbable stitches. Common techniques, often combined, include:
- Lateral tarsal strip: tightens the loose lid at its outer corner (the horizontal laxity)
- Lower lid retractor repair (the Jones procedure, or reinsertion): tightens the muscle that pulls the lid down (the vertical laxity)
- Wies procedure: a lid split with everting stitches that stops the muscle overriding
- Transconjunctival approach: repair from the inner surface of the lid, avoiding a skin incision
- Grafting or lamellar repositioning: for scarring (cicatricial) entropion, where the inner lining is short
Recurrence is a real consideration: operations that do not correct all three mechanisms (horizontal laxity, retractor weakness and muscle override) are associated with higher recurrence, which is why surgeons usually combine techniques.
Ectropion surgery: how it is done
For ectropion, surgery tightens the lower lid, typically at the outer corner, under local anaesthetic in about 45 minutes (BOPSS); more complex cases may need sedation and more time. The lateral tarsal strip is the most commonly used method for age-related ectropion. A medial spindle (a small diamond of tissue removed just below the tear point) can turn the inner part of the lid back in. Scarring ectropion may need a skin graft or a flap. In a retrospective study of 85 lower eyelids treated with a lateral tarsal strip, 95% had a successful result and 4 eyelids (4.7%) needed a second operation. This is one centre's experience, not a promise for any individual.
Recovery and risks
BOPSS describes the typical recovery after entropion surgery like this: the eye is padded overnight; antibiotic drops are used four times a day, plus ointment at bedtime, for two weeks; avoid rubbing the eye; no swimming for 2–3 weeks; flying is allowed within days; and the lid is checked at 10–14 days. After ectropion surgery the eye is padded for at least one day, and the clinic review is one to two weeks later, when the stitches are checked or removed. Your own surgeon sets the exact plan.
Risks include bruising, redness, infection, scarring, recurrence, irritation from the stitches and, rarely, damage to the eye; BOPSS notes that complications are uncommon with specialist surgeons. Overcorrection, where the lid swings too far the other way, is also possible: one eyelid in 85 in the ectropion study above had it.
Is entropion surgery available on the NHS?
NHS guidance on ectropion tells people to see their GP and says surgery is an option when symptoms are severe. Whether a repair is offered, and how long you wait, depends on your local NHS eye service, so ask your GP or eye clinic about both. If the lid is damaging your cornea, say so: that is more urgent than discomfort alone.
Treatment with us
Eyelid and oculoplastic surgery is led by Prof. Dr. Ahmet Satıcı, an ophthalmology specialist since 1992, who sees patients most often for lens replacement, cataract, laser and eyelid surgery, often combined in one trip. Where the cornea has been scratched or ulcerated, Doç. Dr. Muhammet Derda Özer (Doç. is the Turkish title for Associate Professor), our cornea specialist, can advise as well. Surgery for entropion or ectropion is functional eyelid surgery and differs from cosmetic blepharoplasty; your surgeon will tell you which applies to you.
Entropion in dogs and cats: how it differs from entropion in people
Entropion in dogs is the most frequent inherited eyelid defect in many breeds, and the word describes the same fault: the lid margin rolls inwards, so the eyelashes and fur rub against the eye. It is a veterinary condition. We treat people, not animals, so this section only explains what the veterinary sources say and why a vet is needed.
What is entropion in dogs, and which breeds get it?
The Merck Veterinary Manual describes dog entropion as the turning in of the lid edge so that lashes and fur rub on the eye; it may be present from birth or develop later from scarring or eye pain. VCA Animal Hospitals lists breeds in which it is commonly seen, including bloodhounds, bull mastiffs, Chesapeake Bay retrievers, Chinese shar peis, chow chows, Clumber spaniels, Dobermans, English bulldogs, golden retrievers, Labrador retrievers, Neapolitan mastiffs, rottweilers and standard poodles. It is usually diagnosed in puppies under one year old, and most affected dogs have it in both eyes.
What do dog owners see?
Dogs with entropion typically squint, hold the eye shut and tear excessively, and some have a mucus discharge. Left alone, the constant rubbing can cause scarring, colour change on the eye's surface and slow-healing corneal ulcers. Some flat-faced breeds with the inner corner of the lid affected show few signs of discomfort even though the eye is being rubbed, so a vet check matters.
Entropion dog treatment and entropion surgery for dogs
Surgery is the main entropion treatment for dogs: a vet removes a strip of eyelid skin so the lid no longer rolls in. VCA states that most dogs have surgery only once they reach adult size, at 6–12 months, and that more than one operation may be needed to avoid overcorrection. Very young puppies may be given temporary stitches (the Merck manual says they are removed after 2–3 weeks). Where the cause is a spasm from pain, the Merck manual says early cases may reverse if the underlying cause is treated. According to VCA, the outlook after surgery is generally good, and most dogs live normal, pain-free lives. Dogs with severe entropion that needs surgery should not be bred from.
Is there a home remedy for entropion in dogs?
None of the sources describes a home remedy that corrects an inward-rolled eyelid. They say established entropion usually needs surgery, so the safe course is a vet examination rather than home treatment. A dog squinting or weeping from one eye should be seen promptly, because a corneal ulcer can develop.
Entropion dog surgery cost
No authoritative source gives a price for entropion surgery in dogs, and fees vary by country, vet, breed, whether both eyes need surgery and whether a second operation is needed. The practical answer is to ask your vet for a written estimate before you agree.
Entropion in cats, cat surgery and cat surgery cost in the UK
The Merck Veterinary Manual says entropion occurs more frequently in Persian cats and other flat-faced breeds. Causes include inherited eyelid shape, eyelid scarring and excessive blinking from eye discomfort. As in dogs, the options are temporary lid stitches, nerve blocks or medication injections near the lid, and surgery for established cases, and a vet should guide the plan. As above, there is no verified price: ask your UK vet for a written estimate, because we do not treat animals and cannot quote one.
When to see a doctor about an eyelid that turns in or out
Seek same-day care from an eye doctor or an eye emergency service if you have:
- a red, painful eye with sensitivity to light
- blurred vision, or a sudden drop in vision
- discharge, or a white or grey spot on the cornea
- a very red eye with headache and nausea or vomiting
(The NHS lists very red eyes, eye pain, changes in vision, light sensitivity, and headache with sickness as reasons to call NHS 111 or get urgent help.)
Book an appointment soon if you notice:
- a lid that turns in or sags out
- an eye that has been watery, gritty or red for more than a few weeks
- lashes brushing the eye
- repeated conjunctivitis in the same eye
- a lid that will not close fully, or lid changes after facial weakness, injury or surgery
If you already have a diagnosis and want a second opinion on surgery, you can send your reports and photographs for review before you travel.
Frequently asked questions
Entropion is an eyelid that turns inwards, so the lashes and lid edge rub the eye. It is usually the lower lid and most often caused by age-related looseness of the lid, though scarring, inflammation, infection such as trachoma, or muscle spasm can also cause it.
Ectropion is the opposite of entropion: the lower lid turns outwards and droops away from the eye. It causes watery, red, dry eyes because the lid cannot close fully or drain tears properly. Entropion scratches the eye; ectropion exposes it.
The commonest cause is ageing: the tendons, muscles and tissue that hold the lower lid weaken, so the lid edge rolls in. Other causes are scarring after injury, chemical burns, infection or inflammatory disease, and muscle spasm. Some babies are born with it.
Mild congenital entropion in children tends to improve with age, so doctors usually watch it unless the cornea is irritated. In adults, the sources we checked describe surgery as the treatment for established entropion, and an eye that is irritated or scratched should not be left to see whether it settles.
In most established cases by surgery. The surgeon repositions the lid, usually under local anaesthetic as a day case, tightening the lid at its outer corner and repairing the muscle that holds it down. Botulinum toxin can ease spastic entropion temporarily, and treating the underlying cause helps scarring types.
BOPSS says the eye is padded overnight, drops are used for two weeks, swimming is avoided for 2–3 weeks, flying is allowed within days and the lid is reviewed at 10–14 days. Your surgeon will confirm your own plan, including when it is safe to travel.
Rarely, but it can threaten sight. Lashes rubbing the cornea can cause abrasions and ulcers, which in serious cases can damage vision, so an eye with a turned-in lid and pain, light sensitivity or blurred vision needs urgent assessment.
Local NHS services decide. The NHS says to see your GP about ectropion and that surgery is an option for severe symptoms. Ask your GP or eye clinic whether a repair is offered and how long the wait is; if the lid is harming your cornea, tell them.
It is the same inward-rolling lid fault, and it is among the most common inherited eyelid defects in dogs. A vet treats it, usually with surgery to remove a strip of eyelid skin once the dog is full grown at 6–12 months, or with temporary stitches in very young puppies.
Not according to the veterinary sources we checked. They say established entropion usually needs surgery, so a dog with a squinting or weeping eye should see a vet promptly. Home treatment risks missing a corneal ulcer.
No verified figure exists in the sources we checked, and vet fees vary. Ask your vet for a written estimate. We do not treat animals.
Sources for the facts on this page
- British Oculoplastic Surgery Society (BOPSS). Entropion of the upper and lower eyelids (patient information). https://www.bopss.co.uk/public-information/common-conditions/entropion-of-the-upper-and-lower-eyelids/
- British Oculoplastic Surgery Society (BOPSS). Ectropion (patient information). https://www.bopss.co.uk/public-information/common-conditions/ectropion-2/
- British Oculoplastic Surgery Society (BOPSS). Trichiasis (ingrowing eyelashes). https://www.bopss.co.uk/public-information/common-conditions/trichiasis-ingrowing-eyelashes/
- NHS. Ectropion. https://www.nhs.uk/conditions/ectropion/
- MSD Manual Professional Version. Entropion and ectropion. https://www.merckmanuals.com/professional/eye-disorders/eyelid-and-lacrimal-disorders/entropion-and-ectropion
- Comparing surgical outcomes between the Jones and Wies procedures with lateral tarsal strip for involutional lower eyelid entropion. Scientific Reports 2026 (155 patients, 184 eyes). https://pmc.ncbi.nlm.nih.gov/articles/PMC13493771/
- Surgical Outcomes of Transconjunctival Entropion Repair for Lower Eyelid Involutional Entropion: A Retrospective Case Series. Cureus 2026. https://pmc.ncbi.nlm.nih.gov/articles/PMC13340644/
- Transcanthal Canthopexy for Involutional Lower Eyelid Entropion Corrects Horizontal Laxity. Journal of Ophthalmology 2024. https://pmc.ncbi.nlm.nih.gov/articles/PMC10878753/
- Lateral tarsal strip procedure for involutional ectropion: a retrospective analysis of 85 cases and a comprehensive literature review. Advances in Ophthalmology Practice and Research 2021 (snap-back and distraction tests; 95% success). https://pmc.ncbi.nlm.nih.gov/articles/PMC10577831/
- Ectropion Repair Techniques and the Role of Adjunctive Superotemporal Skin Transposition for Tarsal Ectropion. Journal of Clinical Medicine 2025 (types of ectropion and repair). https://pmc.ncbi.nlm.nih.gov/articles/PMC11818440/
- Botulinum Neurotoxin A Injections in Spasmodic Entropion: A Clinical Retrospective Cohort Study. Toxins 2025. https://pmc.ncbi.nlm.nih.gov/articles/PMC12390345/
- Impact of congenital lower eyelid entropion correction surgery on pediatric astigmatism. Frontiers in Medicine 2026 (congenital entropion). https://pmc.ncbi.nlm.nih.gov/articles/PMC13121053/
- Eyelid Malpositions and Ocular Surface Disease: Clinical Correlations and Management Strategies. Journal of Clinical Medicine 2025 (cicatricial entropion). https://pmc.ncbi.nlm.nih.gov/articles/PMC12692792/
- World Health Organization. Trachoma fact sheet. https://www.who.int/news-room/fact-sheets/detail/trachoma
- Merck Veterinary Manual (dog owners). Eyelid disorders in dogs: entropion and ectropion. https://www.merckvetmanual.com/dog-owners/eye-disorders-of-dogs/disorders-of-the-eyelids-in-dogs
- Merck Veterinary Manual (cat owners). Disorders of the eyelids in cats: entropion. https://www.merckvetmanual.com/cat-owners/eye-disorders-of-cats/disorders-of-the-eyelids-in-cats
- VCA Animal Hospitals. Eyelid entropion in dogs. https://www.vcahospitals.com/know-your-pet/entropion-in-dogs
Has an eyelid that turns in or out been bothering your eyes?
Send us your eye report and a clear photo of both eyes. Prof. Dr. Ahmet Satıcı, our eyelid and oculoplastic surgeon, will review them and tell you what treatment may suit you, with no obligation.
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