Epiblepharon is a congenital eyelid condition where an extra horizontal fold of skin and muscle causes the eyelashes to be pushed into a vertical or inward position, rubbing against the eye’s surface. It most commonly affects the lower eyelid and is identified in infants and young children. The condition can occur in one or both eyes.
Symptoms and Diagnosis
The signs of epiblepharon range from non-existent to significantly uncomfortable. Many infants may not show any symptoms because their lashes are soft. As a child gets older, their lashes can become stiffer, leading to irritation, redness, and a persistent foreign body sensation. This can cause frequent eye rubbing, excessive tearing (epiphora), and sensitivity to light (photophobia). Symptoms may worsen when the child looks down, as this motion increases contact between the lashes and the eye.
An ophthalmologist diagnoses epiblepharon through a clinical examination of the eyes and eyelids. Using a slit lamp, a microscope that provides a highly magnified view, the doctor can observe the position of the eyelashes and check the cornea for any scratching or abrasions.
An important part of the diagnosis is distinguishing epiblepharon from entropion. In epiblepharon, the eyelid margin remains in its normal position, and only the extra skin fold causes the lashes to turn inward. When a doctor gently pulls down on this skin fold, the lashes evert to a normal outward position. In entropion, the entire eyelid margin rolls inward toward the eye.
Causes and Prevalence
Epiblepharon results from the specific anatomical development of the eyelids before birth. The cause is related to the structure of the eyelid muscles, specifically an overriding pretarsal orbicularis muscle that pushes a fold of skin over the eyelid margin. This is often combined with a weak attachment of the lower eyelid retractor muscles to the skin, which would normally help keep the lashes properly positioned.
The condition is not considered a genetic or inherited disorder. It has a higher prevalence among individuals of East Asian, Hispanic, and Native American descent, though epiblepharon can occur in children of any ethnicity.
Management and Treatment
Many mild cases of epiblepharon resolve without intervention. As a child’s facial bones mature, the eyelid fold can correct itself, allowing the lashes to turn outward naturally. Because of this high rate of spontaneous resolution, observation is a common initial approach if symptoms are minimal and there is no damage to the eye.
For children experiencing irritation, conservative management involves using lubricating eye drops or ointments to protect the cornea. These lubricants create a barrier between the misdirected eyelashes and the eye, reducing friction and preventing scratches. This approach can manage symptoms while waiting to see if the child outgrows the condition.
If the condition is severe, persists, or causes issues like corneal abrasions, surgery may be recommended. It is reserved for cases where constant rubbing leads to corneal damage (keratopathy) or affects vision, such as through astigmatism.
The surgical procedure removes a small strip of excess skin and underlying muscle. The surgeon then uses sutures to create a defined eyelid crease, rotating the lashes outward. This operation is generally successful with rare complications, permanently relieving discomfort and protecting the eye.