Surgical Correction for Pediatric Epiblepharon and Trichiasis.

Abstract

Lower eyelid epiblepharon is a condition that is common in Asian children and improves with age in most patients; however, the problem can persist until school age or even adulthood. No difference has been observed in terms of incidence in association with sex or the affected eye, and the condition mainly affects the lower eyelid, usually in both eyes. The condition typically features horizontal semilunar skin folds lying parallel to the palpebral margin that accumulate and push the eyelashes towards the ocular surface, which rub against the cornea, resulting in corneal injury and irritation symptoms that affect the daily life of the child. Surgery remains the currently preferred method for alleviating corneal irritation symptoms. Although diverse surgical procedures are available in terms of clinical practice, the modified Hotz procedure remains the most widely used. The surgical procedure primarily focuses on two key aspects: the precise determination of the amount of skin to be removed and improving the tightness between the palpebral retractor aponeurosis and the anterior layer of the eyelid. In this study, lower eyelid epiblepharon is categorized into three distinct types based on the affected area: medial lower eyelid epiblepharon (affecting the medial skin of the lower eyelid); central epiblepharon (involving half of the lower eyelid); and total involvement Type A epiblepharon (involving the full-length of the eyelid). The surgical approach was tailored according to classification, with Type A cases receiving L-shaped excisions and Types B and C crescent-shaped incisions. The postoperative outcomes were evaluated to determine the cure rate. Most patients experienced mild postoperative reactions, and no obvious sunken scars or double lower eyelids were observed. Satisfactory results were thus obtained with mild postoperative reactions.