Objective To explore the therapeutic effect of orbicularis oculi muscle shortening surgery on senile entropion and evaluate its influence on patients' ocular surface function. Methods A total of 40 patients with senile entropion admitted to our hospital from March 2024 to March 2025 were selected as the research subjects,and they were divided into the control group (20 patients) and the study group (20 patients) according to different treatment methods. The control group underwent eyelid skin and orbicularis oculi muscle resection, and the study group underwent orbicularis oculi muscle shortening surgery. The ocular symptoms, ocular surface function, clinical efficacy, satisfaction with aesthetic effect and adverse reactions were compared between the two groups. Results At 3 months after operation, the OSDI score of the two groups was lower than that before operation, and that of the study group was lower than that of the control group (P <0.05). At 3 months after operation, the SIT, BUT, TMH and CFS score of the two groups were better than those before operation, and those of the study group were better than those of the control group (P <0.05). The total effective rate of the study group (100.00%) was higher than that of the control group (70.00%) (P <0.05). The satisfaction with aesthetic effect in the study group was higher than that in the control group, and the incidence of adverse reactions was lower than that in the control group (P <0.05). Conclusion Orbicularis oculi muscle shortening surgery has a definite effect in the treatment of senile entropion. It can improve patients' ocular surface function, alleviate disease symptoms, enhance satisfaction with aesthetic effect, and has high treatment safety .