epiblepharon
Services for Children
Epiblepharon
Some children have lower eyelids with “too much skin” given the size of their face, and this causes their eyelashes to roll inwards. This is called epiblepharon. When the lashes roll inwards enough, they rub against the cornea and cause irritation. Because the lashes are soft, many children with epiblepharon have no symptoms. However, those with symptoms will typically have a clear/white discharge, excessive tearing, and (sometimes) light sensitivity. In severe cases, these symptoms can be significant and, given enough time, the lashes rubbing against the cornea can cause permanent changes to the cornea.
Most children with epiblepharon outgrow it – as their facial dimensions change, the lashes begin to rotate into a normal position (pointing outwards). This development occurs in a temporal to nasal direction (from the ear side towards the nose side). While waiting for natural resolution, the use of lubricating ointments (such as ophthalmic bacitracin) can minimize the symptoms. If a child has epiblepharon beyond the age of 2 or 2 ½ years, it will not likely resolve on its own. In these cases, surgery is indicated – a strip of excess skin (and the muscle under it) is removed from under the lids and, when the skin is sutured back together, the eyelashes roll outwards into a normal position. Initially, the incision site may be noticeable but this dissipates over the next several months and (in my experience) the cosmetic results have been excellent – it’s hard to know that anything was done. In addition to scarring (there is no such thing as cutting without scarring on some level), the risks include a need for reoperation (if too much or too little skin is removed), infection, bleeding, and vision loss/damage (though this is very, very rare). The alternative to surgery is either continued lubrication or no surgery. Without surgery, epiblepharon will not resolve on its own after a certain age and there is a risk of vision loss/damage from corneal scarring.
Most children with epiblepharon outgrow it – as their facial dimensions change, the lashes begin to rotate into a normal position (pointing outwards). This development occurs in a temporal to nasal direction (from the ear side towards the nose side). While waiting for natural resolution, the use of lubricating ointments (such as ophthalmic bacitracin) can minimize the symptoms. If a child has epiblepharon beyond the age of 2 or 2 ½ years, it will not likely resolve on its own. In these cases, surgery is indicated – a strip of excess skin (and the muscle under it) is removed from under the lids and, when the skin is sutured back together, the eyelashes roll outwards into a normal position. Initially, the incision site may be noticeable but this dissipates over the next several months and (in my experience) the cosmetic results have been excellent – it’s hard to know that anything was done. In addition to scarring (there is no such thing as cutting without scarring on some level), the risks include a need for reoperation (if too much or too little skin is removed), infection, bleeding, and vision loss/damage (though this is very, very rare). The alternative to surgery is either continued lubrication or no surgery. Without surgery, epiblepharon will not resolve on its own after a certain age and there is a risk of vision loss/damage from corneal scarring.
