entropion

DEFINITION of entropion

Entropion is an inward turning or inversion of the eyelid margin — most commonly the lower eyelid — causing the eyelashes and lid skin to rub directly against the corneal and conjunctival surfaces of the eye. This constant friction produces corneal irritation, trichiasis, scarring, and in severe or untreated cases, corneal ulceration and vision loss. From a medical-coding perspective, entropion documentation must clarify: Type (involutional/senile, cicatricial, spastic, mechanical, congenital) Laterality (right, left, bilateral) Eyelid (upper vs. lower) Surgical method (suture, thermocauterization, tarsal wedge excision, extensive repair)

These distinctions directly affect both the ICD-10-CM code and CPT code — including which eyelid modifier (E1-E4) applies. Entropion is the direct opposite of ectropion (outward turning of the eyelid). The term derives from New Latin, built on Greek roots meaning “a turning inward.”

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ETYMOLOGY of entropion

greek newlatin - The word is composed of Greek-derived roots via New Latin:

en-: From Greek en, meaning “in” or “inward” — indicating direction of the eyelid fold

trop- / tropo-: From Greek tropē / trepein, meaning “a turning” or “to turn” — the same root found in ectropion and atrophy

-ion: From Greek -ion, a nominalizing suffix forming abstract nouns denoting a state or process

• en- → Greek en, meaning “in, inward”
• trop- → Greek tropē, meaning “a turning”
• entropion literally means “a turning inward.”

Note: The term was coined in New Latin by inverting ectropion (outward turning), which itself derives from Greek ektrepein (ek- = out + trepein = to turn). Entropion entered medical literature in the 19th century.

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Related Terms

Term	Meaning	Coding Relevance
ectropion	Outward turning of the eyelid	Opposite of entropion; separate CPT range (67914-67917); different ICD H02.1-
trichiasis	Misdirected eyelashes rubbing cornea without lid inversion	Can coexist with entropion; H02.05X series; may be coded additionally
blepharospasm	Involuntary forced eyelid closure	May contribute to spastic entropion; not coded separately unless primary diagnosis
lagophthalmos	Inability to fully close the eyelid	May be a surgical complication of entropion repair
corneal ulcer	Full-thickness epithelial corneal defect	Complication of untreated entropion; code additionally (H16.0-)
trachoma	Chlamydial eye infection causing scarring	Leading infectious cause of cicatricial entropion worldwide; A71.- codes
epiblepharon	Extra skin fold turning lashes inward without true lid inversion	Congenital; often confused with entropion; excluded from H02.0-; code Q10.3
ptosis	Drooping eyelid	Distinct condition; different CPT (67901-67904); may coexist with entropion
chalazion	Lipogranuloma of eyelid	Can cause mechanical entropion; coded separately (H00.1-)

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Common Medical Terms Using the Root

• Ectropion - Outward turning of the eyelid (ec- = out + tropion = turning)

• Tropism - Directional growth or movement in response to a stimulus

• Atrophy - Wasting away (a- = without + trophe = nourishment; related Greek root)

• Geotropism - Growth/movement in response to gravity

• Entropy - Shares Greek trope root; concept of turning/transformation

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Common Clinical Indications / Causes

• Involutional (senile): Most common type; age-related laxity of canthal tendons and eyelid retractors

• Cicatricial: Scar tissue from burns, trachoma, chemical injury, Stevens-Johnson syndrome, previous surgery, or radiation

• Spastic: Ocular irritation or post-surgical inflammation triggering orbicularis muscle override

• Mechanical: Weight of an eyelid mass, tumor, or chalazion causing inward rotation

• Congenital: Present from birth; associated with epiblepharon; rare

Signs & Symptoms

• Foreign body sensation and ocular irritation

• Epiphora (excessive tearing)

• Corneal abrasion or ulceration from chronic lash contact

• Photophobia and pain

• Conjunctival injection (redness)

• Mucous discharge

Treatment

• Temporary measures: Taping the lid outward, lubricating drops/ointment, soft bandage contact lens

• Botulinum toxin injection: Weakens orbicularis in spastic entropion (temporary)

• Suture repair (67921): Temporary everting sutures; quick, office-based

• Thermocauterization (67922): Heat applied to stiffen and evert the lid; older technique

• Tarsal wedge excision (67923): Removes a section of tarsal plate

• Extensive repair (67924): Kuhnt-Szymanowski procedure, tarsal strip, or retractor reinsertion; most common for involutional entropion

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Documentation Clues for Coders

Look for phrases such as:

• “Eyelid turning inward”

• “Lashes touching the eye/cornea”

• “Involutional/senile laxity”

• “Tarsal strip procedure”

• “Kuhnt-Szymanowski repair”

• “Retractor reinsertion”

• “Everting sutures placed”

• “Thermocautery to lower lid”

• “Tarsal wedge excised”

• “Right/left upper/lower lid” (determines eyelid modifier E1-E4)

These help determine type, laterality, eyelid position, surgical method, and the correct CPT code + eyelid modifier combination.

Coder’s Notes

• Eyelid modifiers E1-E4 are REQUIRED for entropion repair codes — payers will reject without them

• E1 = upper left eyelid | E2 = lower left eyelid | E3 = upper right eyelid | E4 = lower right eyelid

• Entropion repair codes (67921-67924) are not eyelid-specific in their CPT descriptor — the E modifier is what specifies which lid was repaired

• Do NOT use LT/RT modifiers for entropion repair codes — use E1-E4 instead; LT/RT are for blepharoplasty codes

• Bilateral entropion: Some Medicare carriers require the code billed twice with appropriate E modifiers rather than a single line with modifier 50; verify payer policy

• Congenital entropion is excluded from H02.0- codes (Excludes1 note); use Q10.2 instead — this is a hard Excludes1, not a sequencing issue

• trichiasis without entropion is a distinct code set (H02.05X1-H02.05X9); do not assume they are the same condition

• When entropion and corneal abrasion or ulcer result from the same eyelid malposition, code both — they are not bundled

• Check for CCI edits when billing entropion repair with other oculoplastic procedures on the same day

ICD-10-CM Diagnosis Codes

Code	Description
H02.001	Unspecified entropion of right upper eyelid
H02.002	Unspecified entropion of right lower eyelid
H02.004	Unspecified entropion of left upper eyelid
H02.005	Unspecified entropion of left lower eyelid
H02.011	Cicatricial entropion of right upper eyelid
H02.012	Cicatricial entropion of right lower eyelid
H02.014	Cicatricial entropion of left upper eyelid
H02.015	Cicatricial entropion of left lower eyelid
H02.021	Mechanical entropion of right upper eyelid
H02.022	Mechanical entropion of right lower eyelid
H02.024	Mechanical entropion of left upper eyelid
H02.025	Mechanical entropion of left lower eyelid
H02.031	Senile entropion of right upper eyelid
H02.032	Senile entropion of right lower eyelid
H02.034	Senile entropion of left upper eyelid
H02.035	Senile entropion of left lower eyelid
H02.041	Spastic entropion of right upper eyelid
H02.042	Spastic entropion of right lower eyelid
H02.044	Spastic entropion of left upper eyelid
H02.045	Spastic entropion of left lower eyelid
H02.051	Trichiasis without entropion, right upper eyelid (if applicable)
Q10.2	Congenital entropion (Excludes1 from H02.0- range)

CPT Codes

Code	Description
67921	Repair of entropion; suture
67922	Repair of entropion; thermocauterization
67923	Repair of entropion; excision tarsal wedge
67924	Repair of entropion; extensive (e.g., Kuhnt-Szymanowski, tarsal strip, or retractor reinsertion)

Required Eyelid Modifiers (E1-E4)

Modifier	Eyelid
E1	Upper left eyelid
E2	Lower left eyelid
E3	Upper right eyelid
E4	Lower right eyelid

Other Common Modifiers

Modifier	Use
50	Bilateral procedure — bilateral entropion same session (check payer; may need two lines with E modifiers instead)
22	Increased procedural services — complex repair beyond typical entropion work
51	Multiple procedures — when entropion repair is performed alongside another ocular procedure
79	Unrelated procedure or service by same physician during postoperative period

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DERIVATIONS of entropion

TABLE definition AS Definition
FROM #medterm 
WHERE length(filter(roots, (word) => econtains([[entropion]].roots, word))) > 0 AND file.name != [[entropion]].file.name
SORT file.name ASC

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Query functionality

TABLE definition AS Definition
FROM #medterm 
WHERE length(filter(definition, (word) => econtains([[entropion]].definition, word))) > 0 AND file.name != [[entropion]].file.name

Med roots Appendix A Prefixes Appendix B Combining Forms Appendix C Suffixes Appendix D Suffix forms