What is Epiblepharon?

Epiblepharon refers to the common condition in Oriental patients where the thick muscle tissue just adjacent to the eyelid margin (orbicularis muscle) pushes against the eyelashes and cause them to turn inwards and abrade the eye surface or cornea. A contributing cause is the lack of eyelid retractor fibres extending to the skin, allowing the orbicularis muscle to ride over the eyelid margin. This condition can occur in both lower and upper eyelids but is much more common in the lower eyelids.

How does Epiblepharon affect the eyes?

With the eyelashes abrading the cornea in a chronic fashion, the area of cornea affected may develop scarring. The child may also develop with-the-rule astigmatism in more severe cases. Both these sequelae may pose a risk of amblyopia or lazy eye if undetected and neglected.

highlighted epiblepharon eye clinic case

What causes Epiblepharon?

It is a developmental condition that has the potential to resolve by itself as a child grows older and the face structure matures, allowing the lashes to turn outwards spontaneously.

How common is Epiblepharon among children?

Studies from South Korea have placed the incidence of epiblepharon at about 50% in Oriental children aged less than a year. Local studies show that it constitutes 9.5% of all eyelid surgeries performed in a tertiary referral centre.

What are the symptoms of Epiblepharon?

Most children are surprisingly asymptomatic, even when the lash-corneal touch is significant. The child may complain of occasional eye irritation or itch or dislike of bright light (glare). Or the child’s parents may notice the presence of frequent discharge, tearing and eye rubbing or blinking.

blue light epiblepharon eye

Can adults develop Epiblepharon?

Yes. As the condition may be asymptomatic in childhood when tear volume is plentiful, the patient may only develop symptoms of eye irritation in their later teens or early twenties and therefore present later in life.

It is unusual to present much later in life unless the condition is acquired as a result of other conditions. For example, a patient with thyroid eye disease who has developed forward bulging of the eyes may show a similar condition and this is referred to as being secondarily acquired due to the primary problem of thyroid eye disease.

Treatments available for Epiblepharon

When a child presents before the age of 7 years and the condition is mild, one may adopt a conservative approach and hold on to epiblepharon surgery while observing for spontaneous resolution. However, if the condition is severe, epiblepharon surgery may be indicated earlier.

Surgical Intervention

Several techniques to correct this anomaly have evolved over the decades. Quite a number are described with each centre favouring their own technique. Generally speaking, most involve a reduction in the orbicularis muscle volume and anchoring of the lash-bearing skin fold to the underlying tarsal plate structure, whilst ensuring minimal scarring. In some recalcitrant cases, the medial epicanthic fold has to be addressed as well to reduce recurrence rates.