Objective To investigate the clinical effect and safety of orbicularis oculi muscle folding and shortening combined with eye bag removal surgery in the treatment of senile entropion. Methods A total of 82 patients with senile entropion admitted to our hospital from September 2020 to July 2023 were selected as the research objects. According to the random number table method, they were divided into control group and observation group, with 41 patients in each group. The control group was treated with eyelid skin orbicularis oculi muscle resection, and the observation group was treated with orbicularis oculi muscle folding and shortening combined with eye bag removal surgery. The perioperative indicators, treatment effects and complication rates were compared between the two groups. Results The operation time and hospitalization time of the observation group were shorter than those of the control group, and the blood loss was less than that of the control group (P <0.05). The total effective rate of treatment in the observation group was 95.12%, which was higher than 78.05% in the control group (P <0.05). The incidence of complications in the observation group was 4.88%, which was lower than 24.39% in the control group (P <0.05). Conclusion Orbicularis oculi muscle folding and shortening combined with eye bag removal surgery in the treatment of senile entropion can not only shorten the operation time and hospitalization time, reduce the amount of blood loss, improve the total effective rate of treatment, but also reduce the incidence of complications.