Objective To investigate the effect of different surgical methods in the treatment of senile lower eyelid entropion and trichiasis and its effect on ocular surface function. Methods A total of 120 patients with senile lower eyelid entropion and trichiasis admitted to Chengde County Hospital from October 2021 to October 2022 were randomly divided into group A and group B, with 60 patients in each group. Group A was treated with orbicularis oculi muscle folding and shortening, and group B was treated with orbicularis oculi muscle resection. The clinical efficacy, ocular surface function and postoperative complications were compared between the two groups. Results The total effective rate of treatment in group A was 96.67%, which was higher than 80.00% in group B, and the difference was statistically significant (P0.05). Conclusion The effect of orbicularis oculi muscle folding and shortening in the treatment of senile lower eyelid entropion and trichiasis is better than that of orbicularis oculi muscle resection, which can effectively improve the ocular surface function, and the incidence of complications is smaller and the safety is higher.