Objective To study the effects of two different surgical methods on the treatment of senile patients with upper eyelid entropion and trichiasis and the changes of ocular surface tear film and meibomian gland function. Methods A total of 100 patients with senile upper eyelid entropion and trichiasis admitted to our hospital from January 2022 to January 2024 were randomly divided into control group and observation group, with 50 patients in each group. The control group was treated with transcutaneous orbicularis oculi muscle resection, and the observation group was treated with gray line incision and allogeneic scleral eyelid margin filling. The clinical efficacy, complications, tear secretion test, tear film rupture time and meibomian gland function were compared between the two groups. Results The total effective rate of treatment in the observation group was 96.00%, which was higher than 88.00% in the control group (P <0.05). There was no significant difference in the incidence of complications between the observation group and the control group (P >0.05). The tear secretion test, tear film rupture time and meibomian gland function score of the observation group were better than those of the control group at 1 week, 1 month and 3 months after operation (P <0.05). Conclusion For senile patients with upper eyelid entropion and trichiasis, gray line incision and allogeneic scleral eyelid margin surgery can improve the therapeutic effect, improve the tear film and meibomian gland function of patients, which is worthy of clinical application.