Epiblepharon

Epiblepharon is a congenital eyelid condition in which a horizontal fold of redundant skin and underlying orbicularis oculi muscle pushes the eyelashes inward toward the eye (globe). It most commonly affects the lower eyelids, though the upper eyelids can also be involved. The condition is particularly prevalent among children of East Asian descent and is typically present from birth. Epiblepharon should be distinguished from congenital entropion, in which the entire eyelid margin turns inward; in epiblepharon, the eyelid margin itself remains in a normal position, but the overriding skin fold directs the lashes against the cornea and conjunctiva. The primary symptoms result from the misdirected eyelashes (pseudotrichiasis) contacting the ocular surface. Patients may experience tearing (epiphora), eye irritation, foreign body sensation, photophobia, and chronic eye rubbing. In more severe or persistent cases, the constant contact of lashes against the cornea can lead to punctate corneal erosions, corneal abrasions, and in rare instances, corneal scarring or astigmatism that may affect vision. Many mild cases in young children resolve spontaneously as the facial structures grow and mature, particularly with development of the nasal bridge and redistribution of periorbital soft tissue. Management depends on the severity of symptoms and corneal involvement. In mild cases, conservative treatment with lubricating eye drops or ointments may be sufficient to protect the corneal surface while awaiting spontaneous resolution with facial growth. When significant corneal damage is present or symptoms persist beyond early childhood, surgical correction is recommended. The most common surgical approach involves excision of a strip of skin and orbicularis muscle from the affected eyelid (modified Hotz procedure or similar techniques), which effectively redirects the eyelashes away from the globe. Surgical outcomes are generally excellent with low recurrence rates.

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