Objective To explore the effect of modified orbicularis oculi muscle folding on ocular surface function and aesthetic effect in elderly patients with recurrent lower eyelid entropion. Methods A total of 50 elderly patients with recurrent lower eyelid entropion admitted to the Department of Ophthalmology, the First Affiliated Hospital of Guizhou University of Traditional Chinese Medicine from January to December 2023 were selected, and they were divided into the control group and the observation group by the random number table method, with 25 patients in each group. The control group was treated with conventional orbicularis oculi muscle folding, and the observation group was treated with modified orbicularis oculi muscle folding. The clinical efficacy, ocular symptoms, ocular surface function, aesthetic effect and complications were compared between the two groups. Results The obvious effective rate of the observation group (72.00%) was higher than that of the control group (44.00%) (P <0.05), but there was no statistically significant difference in the total effective rate between the two groups (P >0.05). The ocular symptoms of the observation group at 3 months after operation were better than those of the control group (P <0.05). The BUT, FLS and SIT of the observation group at 3 months after operation were lower than those of the control group (P <0.05). The aesthetic effect scores of the observation group at 3 months after operation were higher than those of the control group (P <0.05). The incidence of complications in the observation group (4.00%) was lower than that in the control group (24.00%) (P <0.05). Conclusion In the treatment of senile recurrent lower eyelid entropion, modified orbicularis oculi muscle folding can not only effectively improve patients' ocular irritation symptoms and restore the normal function of the ocular surface, but also has good aesthetic effects such as hidden incision and natural appearance. Moreover, the operation is safe and the incidence of complications is low.