Objective To compare the clinical effect of orbicularis oculi resection and modiffed orbicularis oculi shortening in the treatment of senile lower eyelid entropion with eyelid laxity. Methods A total of 86 patients with senile lower eyelid entropion and eyelid laxity admitted to the Department of Ophthalmology, Daying County People’s Hospital from March 2021 to August 2024 were selected, and they were divided into the control group and the observation group by the random number table method, with 43 patients in each group. The control group was treated with conventional orbicularis oculi resection, and the observation group was treated with modified orbicularis oculi shortening. The ocular function improvement, satisfaction and complications were compared between the two groups. Results The scores of symptom severity, visual function and environmental stimulus response in the observation group were lower than those in the control group (P<0.05). The scores of appearance satisfaction, functional satisfaction and overall satisfaction in the observation group were higher than those in the control group (P<0.05). The incidence of complications in the observation group was 2.33%, compared with 13.95% in the control group, the difference was not statistically signiffcant (P>0.05). Conclusion Modiffed orbicularis oculi shortening is effective in the treatment of senile lower eyelid entropion with eyelid laxity, which can effectively improve ocular function, enhance satisfaction and achieve high safety.