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Lower eyelid involutional entropion following cataract surgery



To determine whether cataract surgery is associated with an increased risk of subsequent lower eyelid entropion and evaluate potential associated factors.


This retrospective cohort study included consecutive patients undergoing first eye cataract surgery over a 10-year period at a single institution (n = 14,574). The fellow phakic eye served as control. Patient records were evaluated up until either the time of second eye cataract surgery or any other intraocular or adnexal surgery. The primary outcome was the rate of entropion repair in both the pseudophakic (exposed) group and the phakic control group. Groups were compared using relative risk and Kaplan–Meier analysis. Multivariate logistic regression was used to compare pre-specified characteristics of those patients that underwent entropion repair in their pseudophakic eye with those that did not.


A fourfold higher relative risk of undergoing entropion repair was observed in eyes that had undergone cataract surgery compared with the fellow unoperated eye (95% confidence interval 1.6–9.8; P < 0.001) with an increased risk at all timepoints between 1 and 12 years according to Kaplan–Meier analysis (P = 0.001). Median time to entropion repair after cataract surgery was 58 months (range 3–124). Documented intraoperative patient factors such as patient or eye movement, eyelid squeezing, pain or anxiety were an independent risk factor for subsequent entropion (P < 0.0001).


Cataract surgery is associated with an increased risk of subsequent lower eyelid entropion. Surgeons should be aware of this risk in the pre- and post-operative assessment of patients undergoing cataract surgery.

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Fig. 1: Kaplan–Meier Analysis demonstrating the cumulative risk of requiring subsequent entropion repair according to the length of time in years after cataract surgery.
Fig. 2: Involutional changes observed in the lower eyelid after cataract surgery.
Fig. 3: Schematic representation of possible causative mechanism in postoperative entropion.


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All authors contributed to the study’s concept and design, the collection and interpretation of data and preparation of the final manuscript.

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Correspondence to Christopher B. Schulz.

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Schulz, C.B., Fallico, M., Rothwell, A. et al. Lower eyelid involutional entropion following cataract surgery. Eye 36, 175–181 (2022).

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