Entropion in Cats

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What is Entropion in Cats?

Entropion is an abnormal inward rolling of the upper or lower eyelids, causing abnormal, painful friction with the surface of the eye. Entropion is especially irritating to the cornea, or the curved, clear part of the eye. Lower eyelid entropion is most common, and usually occurs toward the outside edge of the eye. The abnormal rolling of the eyelid may introduce hair directly onto the cornea and conjunctiva, causing scratches, ulcers, inflammation, discharge and pain.

Any cat can have entropion; however short-nosed breeds, such as Himalayan and Persian cats, have an increased likelihood for the condition.

Symptoms of Entropion in Cats

Entropion signs vary depending on severity. Most commonly, cats display:

• Squinting

• Eye discharge

• Rubbing the eye

• Nasal discharge

• Swollen eyelids

• Red eyes

• Eyelid spasms

• Raised third eyelid

• Conjunctivitis

• Cloudy cornea and ulceration

Causes of Entropion in Cats

There are three main causes of entropion in cats:

Congenital Entropion

Congenital means “present at birth,” and is usually noticed around two weeks of age, when the eyes open for the first time. This is an uncommon form of entropion in cats.

Anatomical/Developmental Entropion

Anatomical, or developmental entropion, is also rare in cats. This type occurs more often with brachycephalic, or short-nosed breeds, and purebred Himalayan or Persians. In these breeds, the eyes bulge more secondary to a shallow eye socket, causing crowding in the face and subsequent inversion of the eyelid. Researchers have also found this type of entropion in cats with a special hyper-elastic connective tissue condition, called Ehlers-Danlos, in which the tissue stretches abnormally. Anatomical entropion typically affects both eyes.

Acquired Entropion

There are three general types of acquired, or secondary, entropion in cats.

• Spastic entropion is the most common type of entropion in cats. This type is secondary to any other painful eye (ocular) disease, such as corneal ulcers, eye pain, or dry eye, that cause involuntary ocular muscle spasms and subsequent inward rolling of the eyelid.
  
  The eye’s anatomy is initially normal, but chronic irritation, especially from feline herpesvirus-1, causes damage that is sometimes permanent. Most often, spastic entropion involves only one eye, but it can involve both.
   
• Cicatricial entropion is uncommon in cats and happens when the eyelid is damaged or swollen causing an abnormal rubbing of the eye.
   
• Involutional entropion occurs most often in senior cats and involves the loss of the fat pad behind the eye. The loss of fat causes the eye to sink inwards and allows the lid to roll.

How Veterinarians Diagnose Entropion in Cats

Diagnosing entropion in cats is typically straightforward when eyelid hairs are rubbing the surface of the eye.  However, some cases can be more challenging. Many cats, especially those who are in pain, may close or squint their eyes. This leads to intermittent or difficult-to-see entropion. Veterinarians may use a variety of tests to identify entropion and secondary eye issues, including:

• Topical anesthetics: Especially with spastic entropion, numbing the surface of the eye may provide enough relief to allow the eyelid to roll back to a normal position. This is only used for diagnosis. The underlying condition must be identified to resolve the issue.

• Fluorescein stain test: Veterinarians may also perform a fluorescein stain test to look for corneal ulcers. A corneal ulcer will reflect light back, and the stain makes an ulcer glow bright green under a black light.

• Intraocular pressure test: The vet may also use an intraocular pressure test to look for inflammation or glaucoma as a reason for the entropion, or as a secondary side effect.

• Schirmer tear test: Veterinarians may perform a Schirmer tear test to quantify tear production. Low tear production could be the reason for pain, inflammation and irritation, leading to entropion. 

Treatment of Entropion in Cats

Treating entropion in cats depends on the cause for the condition. In most cases of spastic entropion, the underlying disease process must first be identified and corrected. These cats will most commonly be treated for conjunctivitis using a variety of the following medications: 

• Topical and/or oral or injectable antibiotics

• Topical and/or oral or injectable pain medications

• Artificial tears

• Topical or systemic antivirals

Occasionally, cats with spastic entropion may need a temporary procedure called tacking that involves using sutures to keep the eyelid from rolling onto the eye during the healing process.

Eyelid Surgery

Some cats with entropion require surgical correction and typically have an excellent success rate. A veterinary surgeon removes a small elliptical wedge of skin and fur near the eyelid margin. By removing a wedge of tissue, the eyelid flips down into a normal position and no longer rolls onto the eye. Some general practitioners may feel comfortable performing this procedure, but veterinary ophthalmologists may have more experience.

Cost of Entropion Surgery for Cats

Entropion surgery may cost less than $1,000, depending on the veterinarian’s location and experience level, and if the entropion involves one or both eyes. More complicated cases and surgery done by veterinary ophthalmologists may cost several times that amount. 

Hyaluronic Acid Injection

Veterinarians use Hyaluronic Acid (HA) injections as an alternative to surgery, especially in older felines that do not tolerate anesthesia well. HA is a filler-type material that allows the eyelid to be successfully turned outward. This is typically a safe and easy method in more mild cases of entropion. However, the success rate is lower - compared to surgical correction - and may require additional follow-ups and procedures.

Recovery and Management of Entropion in Cats

Cats generally recover well from entropion. For cats that required surgical correction, follow-up appointments are necessary, usually within 10-14 days after surgery. Suture material may be present and will be removed by the veterinarian, although some vets may prefer to use absorbable suture material instead.

During the healing process, the incision area may be red and inflamed with minimal discharge. Cats will need to wear an Elizabethan collar to prevent self-traumatizing the eye or incision. Cats may recover with topical eye medications, as well as oral medications to treat pain, inflammation and to prevent infection.

 Contact a veterinarian if your cat shows the following signs after surgery:

• Pus-like discharge from the incision or eye

• New or worsening redness or swelling around the incision and eye

• New or worsening squinting

• New or worsening cloudiness to the surface of the eye

• Decreased or no appetite

Some cats will have permanent corneal scarring and conjunctivitis even after correction of the entropion and may require life-long medications to maintain eye comfort and health. Optixcare (eye lube plus) is a great general eye lubricating gel that helps soothe and keep the eye moist.

Brachycephalic breeds may benefit from continued lubrication and may help decrease occurrences of entropion in the future. Because most cases of entropion are spastic, it is important to monitor your cat’s eyes closely and seek veterinary treatment quickly. Early intervention offers the best chance of success and return the eye to normal function.