Epiblepharon is an eyelid condition present at birth where an extra horizontal fold of skin causes the eyelashes to turn inward, touching the surface of the eye. This is commonly seen in children, particularly those of Asian, Hispanic, or Native American descent. The condition can affect either the upper or lower eyelid, but the lower lid is more frequently involved.
When Surgery Is Recommended
Many children with epiblepharon do not require immediate surgery, as the condition can improve on its own. As a child grows, facial bone development can cause the skin fold to recede, allowing the lashes to rotate outward. In mild cases, symptoms can be managed with lubricating eye drops or ointments to protect the eye’s surface. Observation is a common approach for young children without significant symptoms.
The recommendation for surgery arises when symptoms become persistent. A primary factor is the constant friction of the eyelashes against the cornea, the clear front part of the eye. This rubbing can lead to chronic eye redness, excessive tearing, persistent itchiness, and frequent eye rubbing. Some children may also develop photophobia, an aversion to bright lights, due to the irritation.
A doctor’s decision to proceed with surgery is based on evidence of damage to the cornea. If the constant lash contact leads to scratches, known as corneal abrasions, or if there is a risk of permanent scarring, surgery is advised. In some instances, neglected epiblepharon can also contribute to astigmatism, a type of refractive error.
The Surgical Procedure Explained
The primary goal of epiblepharon surgery is to reposition the eyelashes, rotating them away from the eyeball. This is achieved by creating a more defined eyelid crease, which stabilizes the lid margin and prevents the lashes from turning inward.
For the lower eyelid, the surgeon makes a fine incision just below the lash line. Through this opening, a small, predetermined amount of excess skin and underlying orbicularis oculi muscle is removed. This step allows the eyelid margin to be turned outward. The surgeon then places internal sutures to create this new orientation and secure the eyelid in its corrected position.
External sutures are used to close the skin incision, creating a new, stable eyelid fold. In children, this operation is performed under general anesthesia to ensure they remain safe and comfortable. Adults undergoing the procedure may only require local anesthesia with light sedation. The surgery is an outpatient procedure, taking approximately 45 to 60 minutes.
Post-Surgery Care and Recovery
Following the operation, some swelling and bruising around the eyes is normal and starts to subside within the first week. The recovery period is straightforward, with most noticeable signs of surgery diminishing over two to three weeks.
Patients are given aftercare instructions to prevent complications. This involves applying a prescribed antibiotic ointment to the incision line to prevent infection. It is important to avoid rubbing the eyes during the recovery period. Follow-up appointments are scheduled to monitor healing and, if non-dissolvable stitches were used, to have them removed about 7 to 10 days after the procedure.
Surgical Outcomes and Potential Complications
Surgical correction of epiblepharon yields positive results with a high success rate. The procedure effectively relieves the irritating symptoms caused by the inward-turning lashes and prevents further damage to the cornea. The scar from the incision is placed in a natural skin crease, such as just below the lower lashes or within the upper eyelid fold, and it heals into a fine line that becomes less obvious over time.
Although the surgery is safe, potential complications are uncommon. These can include under-correction, where the epiblepharon recurs, or over-correction, where the eyelid turns too far outward in a condition known as ectropion. Other risks include visible scarring or, more rarely, an infection at the incision site.