Objective To investigate the clinical effect of orbicularis oculi muscle shortening and lower eyelid retractor repositioning in the treatment of patients with senile lower eyelid entropion. Methods A total of 96 patients with senile lower eyelid entropion admitted to Shaoxing People’s Hospital from July 2023 to November 2025 were selected, and they were divided into the control group and the observation group by the random number table method, with 48 patients in each group. The control group received orbicularis oculi muscle resection, and the observation group received orbicularis oculi muscle shortening and lower eyelid retractor repositioning. The clinical efficacy, aesthetic effect, aesthetic satisfaction and complication rate were compared between the two groups. Results The total effective rate of the observation group was 93.75%, which was higher than 79.17% of the control group (P<0.05). The aesthetic effect and scores of aesthetic satisfaction in the observation group were better than those in the control group (P<0.05). The incidence of complications in the observation group was 4.17%, which was lower than 16.67% in the control group (P<0.05). Conclusion Orbicularis oculi muscle shortening combined with lower eyelid retractor repositioning has reliable clinical efffcacy for senile lower eyelid entropion. It can effectively optimize ocular aesthetic morphology, improve aesthetic satisfaction, and has fewer postoperative complications and higher safety.