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Background/aims The aim of this study was to compare tissue reactions and scarring produced by polypropylene (Prolene) versus polyglactin 910 (Vicryl) sutures in eyelid skin.Methods 47 patients with entropion were randomised to 6–0 Prolene or 6–0 Vicryl. Patients underwent everting sutures 1 month prior to definitive surgery involving wedge excision and retractor plication. Only the randomised suture type was used in both procedures. The study suture within the wedge was analysed histologically. Patients were assessed clinically 2 weeks and 6 months following definitive surgery.The primary outcome was histological inflammatory reaction diameter around the suture assessed by a masked histopathologist. Secondary outcomes were clinical scarring assessed using a validated scar grading questionnaire completed by patients and masked assessors and clinical photographs assessed by two masked oculoplastic surgeons.Results Mean inflammatory reaction diameter was 0.39 mm for Prolene and 0.56 mm for Vicryl. Median histological grade sum was 32 (IQR 22–37) for Prolene and 40 (IQR 27–46) for Vicryl. The median number of foreign body giant cells around the suture was 1 (IQR 0–3) for Prolene and 4 (IQR 3–8) for Vicryl. Only this last result was statistically significant; the lack of significance for other results may be due to the small sample size. One patient developed a clinical granuloma following surgery with Vicryl. There was no significant difference between suture scarring assessed by questionnaire responses or clinical photography.Conclusion Prolene may cause less histological inflammation than Vicryl in eyelid skin but clinical scarring is similar.Trial registration number NCT04724512.