Epiblepharon Surgery in Singapore
Examples of Epiblepharon concerns prior to surgery. Note how the lashes touch and irritate the corneal surface of the eyes.
What is epiblepharon?
Epiblepharon refers to the excessive skin fold along the eyelid margin that causes the adjacent eyelashes to be turned inwards and touch the cornea. This causes a variable level of discomfort, with some children tolerating it better than others. Epiblepharon is more commonly seen in East Asian children. Usually, only the lower eyelid is affected. However, some children have both upper and lower lid epiblepharon.
Treatments for Epiblepharon
Treatment for epiblepharon depends on the severity of the condition and the presence of any corneal damage. When the lashes constantly rub against the cornea, it can cause damage to the corneas. Some children with mild epiblepharon may grow out of the condition as their facial structure matures. These mild cases of epiblepharon would not require surgery and are often treatable with ointment or lubricating eye drops.
Epiblepharon surgery involves the removal of a small area of excess skin and muscle from the area below the lid margins, allowing the lashes to rotate outwards. As with all surgeries, a faint line may appear where the incision is made, but it typically fades over time.
Does my child require surgery? If so, when is a good time to undergo surgery?
Surgery is often recommended when the child experiences significant discomfort or when corneal abrasions are noted. Occasionally, neglected epiblepharon may cause increasing astigmatism. It is, therefore, good to know the child’s refraction when making the decision whether to undergo surgery. The surgery can be timed electively during school holidays with lubricant eye drops and gel medications tiding the symptomatic child over till then. Consult our expert eye specialist based in Singapore to discuss if epiblepharon surgery is suitable for your child.
Will there be a visible scar after surgery?
The surgical scar is often hidden in the area just below the lower eyelid margin. This subciliary area tends to heal well and most parents and children are not bothered by the fine line that mimics a natural skin line. In the upper eyelid the surgical scar is hidden in the upper eyelid crease. In many cases where the child did not have a “double eyelid” prior to surgery, the family is often delighted to see one present after the surgery.
When should I bring my child to visit an eye specialist?
Surprisingly, epiblepharon can be asymptomatic as the child’s copious tear film prevents surface irritation on the cornea. In other cases, itching, tearing, and redness of the eyes can result from the eyelashes rubbing against the cornea. If you notice that your child is frequently rubbing his or her eyes, you can observe them while they look downwards and upwards. In these positions, symptoms become more noticeable as the inward rotation of the lashes is exacerbated and causes greater corneal touch. If you suspect your child to have epiblepharon, you can bring them to an eye specialist or an eye clinic in Singapore to assess the severity of their condition. At Ava Eye Clinic, Dr Looi has the oculoplastic expertise and experience to help rectify this problem.
It is true that some children with mild cases may outgrow the condition. This typically happens between the ages of 4 and 7 as the facial bones mature and the bridge of the nose becomes more prominent. This can naturally pull the skin fold away and rotate the lashes outward.
We often adopt a wait-and-see approach for very young children if the symptoms are manageable. We recommend regular monitoring so that we can intervene with epiblepharon surgery only when it becomes clear that the child’s natural growth is not correcting the lash position quickly enough. In some severe cases, however, if the lashes are constantly rubbing against the eye and causing discomfort or redness, The condition is unlikely to resolve on its own before damage occurs. In such cases, surgery may be recommended earlier.
As an eye specialist, we look for signs of punctate staining, which are tiny scratches on the cornea (the clear front window of the eye) caused by the constant rubbing of the lashes against the cornea. To a parent, the child may appear to have a chronically red eye, frequent tearing or eye rubbing, or unusual sensitivity to bright lights (photophobia). If left unmanaged, these corneal abrasions could lead to secondary infections or permanent corneal scarring. We use a special yellow dye (fluorescein) during our assessment to visualise these scratches under a blue light. If we see significant staining, it indicates that the lashes are actively damaging the corneal surface and that corrective action is necessary to protect your child’s long-term vision.
The key difference lies in the physical position of the eyelashes. In a child with allergies (allergic conjunctivitis), the eye rubbing is usually seasonal or triggered by environmental factors like dust or pollen. With epiblepharon, the irritation is mechanical and constant because the lashes are physically turned inward. At Ava Eye Clinic, our specialists perform a detailed slit-lamp examination to see if the eyelid skin fold is actually pushing the lashes onto the eyeball. It is also possible for a child to have both conditions simultaneously, where the allergies make the eye more sensitive to the already irritating lashes. A professional diagnosis is essential to ensure we are not treating the itch while ignoring the underlying physical cause.
Yes, severe and untreated epiblepharon can have long-term effects on a child’s visual development. The constant pressure of the eyelid fold and the lashes against the cornea can actually warp the shape of the eye over time, leading to significant astigmatism. If the corneal scarring becomes central, it can result in blurred vision. When one eye sees more clearly than the other, the brain may begin to favour the stronger eye, potentially leading to amblyopia, commonly known as lazy eye. This is why epiblepharon surgery in Singapore is often considered a preventative measure; by correcting the lid position early, we ensure the cornea remains smooth and clear during these critical years of visual growth.
In a standard epiblepharon surgery, the incision is placed very strategically, just 1 to 2 mm below the lower eyelashes. Because the skin in this area is very thin and heals remarkably well, the resulting scar usually fades into a faint, nearly invisible line that blends into the natural skin creases of the lower lid. We use meticulous suturing techniques to ensure the wound edges are perfectly aligned. Over several months, the slight redness of the new scar transitions to a skin-toned color, and once fully healed, it is typically very difficult to detect even upon close inspection.
Yes, in the upper eyelid, an excess of skin and bulky orbicularis muscle can also result in the eyelashes pushed inwards, onto the cornea. Surgery is required to reduce the soft tissue bulk and rotate the eyelashes outwards. A happy side benefit is that children who need this surgery acquire double eyelids following the surgery. This can cause some confusion as parents who are not aware of this condition may make the mistake of thinking that the child’s parents had organised cosmetic surgery for their child.
For our paediatric patients, the procedure is almost always performed under general anesthesia. This is primarily to ensure the child remains perfectly still, as the surgery involves working very close to the eye with high precision.
Modern anesthesia is extremely safe, and your child will be monitored by a dedicated specialist anesthetist throughout the entire process. The surgery itself is relatively quick, typically taking about 60 minutes for both eyes. Some techniques for severe cases may take longer. At Ava Eye Clinic, we prioritise a child-friendly environment to reduce anxiety before the procedure. Most children wake up within 10 minutes after completion of surgery, feeling slightly groggy but generally comfortable.
Yes, because epiblepharon is a structural abnormality that causes physical irritation and potential damage to the cornea, the surgery is classified as a medically necessary reconstructive procedure rather than a cosmetic one. It is therefore eligible for MediSave claims. Photographs will be taken to show the lash-corneal touch to back up medical claims.
Parents in Singapore can typically use their own or their child’s MediSave account to offset the surgical costs. Our administrative team at Ava Eye Clinic will assist you with the necessary paperwork and provide a breakdown of the claimable limits, ensuring that the financial aspect of your child’s care is as seamless as possible.
Since the condition is medically diagnosed and can lead to vision-threatening complications like corneal scarring, most Integrated Shield Plans and private corporate insurances in Singapore do provide coverage for the procedure. To facilitate your claim, Ava Eye Clinic will provide a detailed medical report and photographs proving the severity of the lash-to-cornea contact. We often recommend obtaining a Pre-Authorisation or a Letter of Guarantee (LOG) from your insurer before the surgery date so that you have full clarity on the extent of your coverage and any potential co-payments.
We generally recommend that children take about a few days off from school to rest and allow the initial swelling to subside. During the two weeks, it is important to avoid dusty environments and avoid rubbing the eyes. Regarding physical activity, we advise a total break from PE lessons and strenuous play for at least two weeks to prevent any accidental trauma to the surgical site. Swimming is the most restricted activity; your child should avoid swimming pools and the ocean for at least one month after epiblepharon surgery to prevent any risk of infection while the incision line is fully maturing.
It is normal for children to have some degree of swelling and bruising for the first 3 to 5 days after surgery. This is just a natural part of the healing process and usually fades to a yellowish tinge before disappearing by the end of the first week. Managing itch is crucial because any strong eye rubbing could pull the wound edges apart and cause bleeding. At Ava Eye Clinic, we prescribe specialised antibiotic ointments that also help soothe the skin. We also provide clear instructions on wound dressing and how to use cold compresses to reduce both swelling and itch.