Objective To explore the effect of orbicularis oculi muscle folding and shortening combined with pouch plastic surgery in elderly patients with entropion. Methods Sixty patients with senile entropion admitted to our hospital from February 2022 to January 2023 were selected as the research objects. They were divided into control group and observation group by random number table method, with 30 patients in each group. The control group was treated with orbicularis oculi muscle folding and shortening, and the observation group was treated with orbicularis oculi muscle folding and shortening combined with pouch plastic surgery. The surgical effect, perioperative indicators, postoperative complications, aesthetics, quality of life and recurrence were compared between the two groups. Results The total effective rate of the observation group was 96.67%, which was higher than 73.33% of the control group (P<0.05). The operation time, intraoperative blood loss and hospitalization time of the observation group were shorter than those of the control group (P<0.05). The incidence of complications in the observation group was 6.67%, which was lower than 16.67% in the control group, but the difference was not statistically significant (P >0.05). The scores of scar, comfort, appearance, trichiasis correction and symmetry in the observation group were higher than those in the control group (P<0.05). After treatment, the quality of life score of the observation group was higher than that of the control group (P<0.05). The recurrence rate of the observation group was 0, which was lower than 13.33% of the control group (P<0.05). Conclusion The effect of orbicularis oculi muscle folding and shortening combined with pouch plastic surgery in elderly patients with entropion is better, with less adverse reactions, which can improve the postoperative aesthetics of patients and improve the quality of life of patients. It is worthy of clinical application.