Astigmatism in Children With Epiblepharon

Congenital epiblepharon in Chinese school-age children: a cross-sectional study

PURPOSE

To investigate the prevalence and body mass index (BMI) associations of congenital lower epiblepharon in children in China and the difference in the refractive errors between children with and without epiblepharon.

METHODS

Children 6-12 years of age in Beichen District of Tianjin were screened for congenital epiblepharon from September to October 2017. All children underwent slit-lamp examination, strabismus screening, visual acuity examination and refraction. Weight and height were also recorded. The prevalence of lower epiblepharon in school-age children was evaluated, and its association with age, sex, BMI, and refractive error was analyzed.

RESULTS

A total of 28,225 children were examined; 564 had epiblepharon. The prevalence of epiblepharon was found to be, for 6-year-olds, 2.50%; for 7-year-olds, 2.13%; for 8-year-olds, 2.10%; for 9-year-olds, 1.97%; for 10-year-olds, 1.85%; for 11-year-olds, 1.67%; and for 12-year-olds, 1.19% (P < 0.05). The prevalence of overweight and obesity in children with epiblepharon was found to be 16.7% and 47.2%, respectively. The prevalence and degree of astigmatism was higher than in nonepiblepharon children. We found a possible association between severity of astigmatism and severity of epiblepharon.

CONCLUSIONS

In our study, the prevalence of epiblepharon decreased with advancing age, and the majority of children with epiblepharon were found to be overweight or obese. Epiblepharon was associated with astigmatism.

Sensory Function of Children With Strabismus After Epiblepharon Surgery

PURPOSE

To investigate the effect of epiblepharon surgery on motor and sensory function in children with epiblepharon and concomitant strabismus.

METHODS

Among 564 patients who underwent epiblepharon correction surgery from May 2016 to April 2023, 45 children who were examined for strabismus were included in the study. Preoperative and postoperative visual acuity, refraction, and angle of deviation were analyzed. For those with significant angle of deviation, additional stereopsis, sensory fusion, and returning time were retrospectively investigated. The angle of deviation was examined by one examiner at distance and near.

RESULTS

The mean age of 45 children (18 boys and 27 girls) was 6.8 ± 2.9 years. Fifteen had significant strabismus at the time of epiblepharon surgery. Visual acuity improved in both the total and strabismus groups. Improvement in stereopsis and fusion was also observed in the strabismus group. The angle of deviation showed no difference in both groups.

CONCLUSIONS

Epiblepharon could affect ocular manifestations of strabismus as shown in this study. The authors suggest strabismus treatment be continued after epiblepharon surgery, with improved sensory function. Further evaluation with larger groups is needed in the future. [J Pediatr Ophthalmol Strabismus. 2024;61(4):257-261.].

Comparing the effectiveness of two surgical techniques for treating lower lid epiblepharon in children: a randomized controlled trial

A multicenter randomized controlled trial was conducted to compare the effectiveness of incisional and nonincisional surgical techniques for treating lower lid epiblepharon in children. The study included 89 eyes from 50 children aged 3-15 years (mean, 7.5 ± 2.4 years) with moderate lower lid epiblepharon. Patients were randomly assigned to either incisional (modified Hotz procedure with lid margin splitting; 45 eyes of 25 patients) or nonincisional (44 eyes of 25 patients) surgery groups. Treatment outcomes and changes in astigmatism were evaluated 6 months after surgery. Incisional surgery provided a significantly higher percentage (77.8%) of well-corrected treatment results (P = 0.026; odds ratio, 2.88; 95% confidence interval, 1.07-8.22) than nonincisional surgery (55.4%). The mean change in astigmatism 6 months after surgery was - 0.24 ± 0.42 and - 0.01 ± 0.47 D in the incisional and nonincisional surgery groups, respectively. The improvement in astigmatism was significantly higher in the incisional surgery group than in the nonincisional surgery group (P = 0.008). The incisional surgical treatment for moderate epiblepharon in children resulted in a higher number of well-corrected patients, indicating an absence of both ciliary touch and superficial keratitis as well as statistically significant improvements in astigmatism correction.

Analysis of Changes in High-order Aberration and Contrast Sensitivity After Epiblepharon Surgery

PURPOSE

To investigate changes in corneal anterior high-order aberration (HOA) and contrast sensitivity (CS) before and after epiblepharon surgery.

METHODS

A retrospective observational analysis of the degree of corneal erosion, HOAs and CS was conducted in the OD and OS, respectively, before and after epiblepharon surgery. The correlations between corneal erosion, HOAs, and CS were analyzed.

RESULTS

Forty-nine patients were included in the study. Among the anterior HOAs, total HOA, coma, and trefoil showed significant improvement after surgery ( P = 0.003, P = 0.009, and P = 0.018, respectively). In the CS test, there was a significant improvement in CS after surgery at 1.1 cycles per degree (cpd) under photopic conditions, regardless of glare. Preoperative correlation analysis between HOAs and corneal erosion showed a significant positive correlation with total HOA ( P = 0.001) and coma ( P = 0.001). Preoperative correlation analysis between CS and corneal erosion showed a significant negative correlation at 1.1 cpd with glare under photopic conditions ( P = 0.049). A negative correlation was also observed between CS under mesopic and photopic conditions and total HOA both before and after surgery.

CONCLUSION

Significant improvement in corneal anterior HOAs and CS at 1.1 cpd under photopic conditions was observed after epiblepharon surgery. Total HOA of anterior cornea showed a negative correlation with CS. A decrease in HOAs and recovery of corneal erosion after epiblepharon surgery will help improve CS.

Minimal lower eyelid epicanthoplasty combined with thermal contraction to treat epiblepharon in chinese children

BACKGROUND

To evaluate the clinical efficacy of combined minimal lower eyelid epicanthoplasty and thermal contraction for epiblepharon repair in Chinese children.

METHODS

Between January 2017 and August 2020, a single surgeon corrected epiblepharon in Chinese children using minimal lower eyelid epicanthoplasty combined with thermal contraction. First, a minimal epicanthoplasty flap to balance the lower eyelid was made cross the lower eyelid epicanthus, which connected with a 20-mm-long incision 1.5 mm below the lower eyelid margin. After removing the hypertrophic orbicularis oculi muscle running between the lower epicanthal fold and the medial canthal tendon, thermal cauterization was applied to increase lower eyelid rotation by creating adhesions between the lower eyelid retractor and tarsus. The residual medial edge was sutured to the corner of the epicanthus to decrease the lower eyelid epicanthus. The postoperative follow-up ranged from 3 to 24 months. We retrospectively analyzed cases to determine whether this approach decreased the lower eyelid epicanthal fold to equalize the tension of the lower eyelid. The surgical outcomes including the direction of lower eyelid eyelashes, complications, and refractive errors were evaluated.

RESULTS

Data from each eye of 53 Chinese children (29 female, 24 males; mean age: 5.3 ± 2.3 years) who had undergone minimal lower eyelid epicanthoplasty combined with thermal contraction were included. During follow-up, recurrence was observed in just one of the 106 eyes (0.94%), and two eyes (1.89%) showed under-correction. No visible scars formed in the postoperative period. All patients' parents were satisfied with the cosmetic results and had no serious complaints. The mean astigmatism was significantly reduced by the surgery from 1.82 ± 0.45 diopters (D) preoperatively to 1.43 ± 0.36 D postoperatively (P < 0.05).

CONCLUSION

This surgery is easy to design, time-efficient, and is effective in the correction of epiblepharon. The procedure allows surgeons to achieve good appearance and natural eyelid contour without apparent complications.

Sex-Specific Effect of Obesity on Epiblepharon in Different Age Groups: A Case-Control Study

Obesity has been regarded as a risk factor for several ocular diseases. This study aims to investigate the age- and sex-specific relationship between epiblepharon and obesity in children. A retrospective case-control study was conducted using the Chang Gung Research Database. Children ≤ 18 years of age with epiblepharon were identified from 1 January 2009 to 31 December 2019. Children were classified into three groups: normal, overweight and obese groups. A total of 513 patients and 1026 controls (57.7% males) aged 1 to 18 matched by sex and age were included in the analysis. The median body mass index (BMI) of children with epiblepharon was significantly higher than that of children without epiblepharon (p < 0.001). In the subgroup analysis, among boys aged 4 to 9 years, the BMI in boys with epiblepharon was significantly higher than that in boys without epiblepharon (p < 0.05) and the risk of epiblepahron in overweight/obese boys was significantly higher than in non-overweight boys (OR = 1.74, 95% CI = 1.07-2.82 for age 4 to 6; OR = 3.06, 95% CI = 1.56-6.03 for age 7 to 9). On the other hand, among girls aged 13 to 18 years, the BMI in adolescent girls with epiblepharon was significantly higher than that in the control group (p < 0.05) and overweight/obese girls had a statistically higher risk of persistent epiblepharon than non-overweight girls (OR = 3.70, 95% CI = 1.38-9.97). The association between obesity and epiblepharon varies in strength according to age in a sex-specific manner.

Comparing Changes in Corneal Astigmatism Using Scheimpflug Camera after Epiblepharon Correction Surgery

Purpose: To evaluate the changes in corneal astigmatism before and after epiblepharon correction surgery with a Scheimpflug camera.Methods: From April, 2019, to June, 2020, 48 eyes of 24 patients underwent epiblepharon correction surgery. The patients were divided into two subgroups by age and their best corrected visual acuity (BCVA) and corneal anterior and posterior astigmatism were compared before and after correction surgery.Results: There was no difference in BCVA after the correction surgery. To assess the changes in the keratometric value and astigmatism after epiblepharon surgery, a Scheimpflug camera was used. The anterior flat and mean keratometry changed from 42.10 ± 1.46 to 42.43 ± 1.10 D (p = 0.035) and from 42.97 ± 1.26 to 43.21 ± 1.15 D (p = 0.012), respectively, while the posterior corneal astigmatism changed from 0.44 ± 0.31 to 0.35 ± 0.17 D (p = 0.047). There were no significant changes in steep keratometry (p = 0.191) or anterior corneal astigmatism (p = 0.126).Conclusions: There were significant changes after epiblepharon correction surgery in anterior keratometry reading and posterior corneal astigmatism.

The prevalence of lower eyelid epiblepharon and its association with refractive errors in Chinese preschool children: a cross-sectional study

Background

To assess the prevalence and demographics of lower eyelid epiblepharon in Chinese preschool children and to evaluate its association with refractive errors.

Methods

In this population-based, cross-sectional study, a total of 3170 children aged 3 to 6 years from Beijing, China underwent examinations including weight, height, cycloplegic autorefraction and slit-lamp examination of external eyes. The prevalence of lower eyelid epiblepharon in preschool children was evaluated and its association with age, sex, body mass index (BMI), and refractive errors was analyzed using logistic regression analysis.

Results

The prevalence of lower eyelid epiblepharon was 26.2%, which decreased with age, with prevalence in 3-, 4-, 5-, and 6-year-olds of 30.6, 28.0, 15.0, and 14.3%, respectively. Boys had a higher risk of having epiblepharon than girls (OR = 1.41; 95%CI, (1.20–1.66)) and no significant correlation was detected between BMI and epiblepharon after adjusting for age and sex (p = 0.062). Epiblepharon was significantly associated with a higher risk of refractive errors, including astigmatism (OR = 3.41; 95% CI, (2.68–4.33)), myopia (OR = 3.55; 95% CI, (1.86–6.76)), and hyperopia (OR = 1.53; 95% CI, (1.18–1.99)).

Conclusions

There is a high prevalence of lower eyelid epiblepharon in Chinese preschool children, particularly among boys and younger children. Preschoolers with lower eyelid epiblepharon are subject to a higher risk of developing astigmatism, myopia, and hyperopia, than those without. Increased attention should be paid to this eyelid abnormality in the preschool population.

Effect of Congenital Lower Eyelid Epiblepharon Surgery on Asymmetric Margin Reflex Distance 1

Objectives: To investigate the characteristics of margin reflex distance 1 (MRD1) asymmetry in congenital lower eyelid epiblepharon and its resolution after surgical correction of epiblepharon.Methods: Among patients who underwent lower eyelid epiblepharon surgery from November 2015 to September 2017, patients with a preoperative MRD1 difference of more than 1.0 mm between the two eyes according to medical photographs were defined as having MRD1 asymmetry. A postoperative MRD1 difference of less than 1.0 mm between the two eyes was regarded as MRD1 asymmetry resolution. The preoperative MRD1 difference was compared between subgroups with resolved or sustained MRD1 asymmetry. Astigmatism and amblyopia were also assessed.Results: Among 432 patients, MRD1 asymmetry was observed in 24 patients (5.6%). MRD1 was always lower in the side with more extensive epiblepharon. At 6 months after surgery, the mean MRD1 difference between the two eyes was significantly decreased (1.8 ± 0.7 mm to 0.5 ± 0.8 mm, p < .001, paired t-test) and MRD1 asymmetry resolution occurred in 19 patients (79%). In the resolved MRD1 asymmetry group, the preoperative MRD1 difference was 2.0 mm or less and was significantly smaller than that in the sustained MRD1 asymmetry group (p = .010, Mann-Whitney U test). Six patients had preoperative aniso-astigmatism ≥ 1.50 D. Unilateral amblyopia presented in nine patients (38%) and improved within 1 year postoperatively.Conclusions: MRD1 asymmetry can be resolved after epiblepharon surgery, especially when the preoperative MRD1 difference is 2.0 mm or less. Unilateral amblyopia was frequent, but the treatment outcome was good.

Surgical Treatment of Epiblepharon Effectively Alleviates Keratopathy but Not Astigmatism: A Case-Control Study Utilizing Vector Analysis in East Asian Children

Purpose

To identify an appropriate surgical indication of epiblepharon by comparing keratopathy and astigmatism outcomes after surgical and medical treatments for epiblepharon in Asian children.

Methods

Children diagnosed with epiblepharon (n = 82, age 5.93 ± 2.76 years) with >6 months of follow-up were enrolled. The clinical presentations and cycloplegic refractive status at the baseline and 3 and 6 months after treatment were compared between surgical (91 eyes from 47 children) and nonsurgical (67 eyes from 35 children) groups. The refractive and keratometric astigmatism at each time point were evaluated with vector analysis methods. For Thibos and Horner's method, the astigmatic power vector was decomposed into horizontal and oblique meridians (J₀ and J₄₅). However, the treatment-induced astigmatism (TIA) vectors were calculated by Alpins' method and depicted by the AstigMATIC software.

Results

In the surgical and nonsurgical groups, the baseline astigmatism magnitude was similar (2.22 ± 1.39 and 2.26 ± 1.46 D, p = 0.87). The rate of complete resolution of keratopathy at 6 months was 71.4% and 11.5%. The astigmatism magnitude in the surgical group differed among baseline and 3 months (2.25 ± 1.23 D) and 6 months postoperatively (1.97 ± 1.28 D) (p = 0.001). Power vector analyses confirmed a nuanced against-the-rule shift in the surgical group. This trend was especially observed in the subgroup of baseline astigmatism >2.0 D. However, the difference in the astigmatism magnitude between surgical and nonsurgical groups, even in highly astigmatic children, was not significant at 6 months.

Conclusions

The improvement of keratopathy in the surgical group was greater than that in the nonsurgical group in consideration of the more advanced severity in the surgery group at baseline. Decreased with-the-rule astigmatism can be observed at 6 months postoperatively, particularly among those with greater baseline astigmatism. However, the amount of change is small, and the outcome does not differ significantly from the nonsurgical treatment. Therefore, surgical indications should majorly base on the severity of symptoms and keratopathy.

Analysis of corneal real astigmatism and high order aberration changes that cause visual disturbances after lower eyelid epiblepharon repair surgery

This retrospective, cross-sectional study investigated changes in corneal low and high order aberrations (LOAs and HOAs) after lower eyelid epiblepharon repair surgery. In total, 108 eyes from 54 patients were evaluated. Wavefront analyses for calibrated LOAs and HOAs were performed using a Galilei G4 Dual Scheimpflug Analyzer before surgery and during the first and second follow-ups (f/u), adjusting for several risk factors. Flat keratometry (K) and axis values decreased significantly from baseline at the first f/u. At the second f/u, mean K and axis values decreased. Coma and trefoil increased from baseline at the first f/u and normalized by the second f/u. Spherical aberrations (SA) only decreased at the second f/u. After correction for risk factors, cylinder, coma, trefoil, and SA significantly increased at the first f/u; axis and flat K values decreased. At the second f/u, cylinder increased while axis and mean K values significantly decreased. Epiblepharon repair surgery may result in a shift from 'with-the-rule' to 'against-the-rule' axis change. Flat K, coma, and trefoil may be affected by mechanical force changes immediately post-surgery, while mean K values and SA may also change with corneal state changes including corneal erosion healing after the second f/u during the postoperative period.

Relationship between lower eyelid epiblepharon and epicanthus in Korean children

PURPOSE

This study aimed to determine the relationship between lower eyelid epiblepharon and epicanthus in Korean children.

METHODS

We performed a retrospective review of the medical records and preoperative photographs of 119 patients. These patients were aged 18 years or younger who underwent lower lid epiblepharon repair from January 2010 to December 2012. We also included 119 age- and sex-matched controls.

RESULTS

The mean age of the patients was 5.7 years (range: 2-16 years) in both groups. The presence of an epicanthal fold was common in each group (98.3%). The inner intercanthal distance/interpupillary distance (IICD/IPD) ratio was significantly greater in the epiblepharon group than in the control group (mean: 0.70 vs 0.67, p<0.001), especially in those aged 5 years or older. The IICD/outer intercanthal distance ratio was also greater in the epiblepharon group than in the control group (mean: 0.48 vs 0.46, p<0.001). The IICD/IPD ratio decreased with growth in the control group, but it did not decrease with growth in the epiblepharon group. The configuration of the epicanthus, in which the upper skin fold formed a confluent fold with the lower eyelid, had a higher prevalence in the epiblepharon group than in the control group (p = 0.001), especially in those aged 5 years or older.

CONCLUSION

In early childhood (<5 years), the relationship between epicanthus and epiblepharon cannot be established because of the high prevalence of epicanthus in children with or without epiblepharon. In children aged ≥5 years, persistent epicanthus was related to severe epiblepharon formation requiring corrective surgery.

Management of epiblepharon: state of the art

PURPOSE OF REVIEW

Epiblepharon is prevalent in East-Asian children. As the population in Asia is increasing, so is the demand for epiblepharon surgery. Surgeons should be familiar with the standards of beauty and needs of Asian people for epiblepharon management. This review provides a comprehensive summary of the published studies on the clinical manifestations, pathophysiology, and management of epiblepharon.

RECENT FINDINGS

Astigmatism is prevalent in epiblepharon patients, which can contribute to amblyopia. Early surgery and visual rehabilitation is important for epiblepharon patients with a high degree of astigmatism and amblyopia. Various etiologic factors play a role in the pathophysiology of epiblepharon. Surgical procedures focusing on creation of a lower eyelid crease have been popular for treating epiblepharon in Western textbooks; however, this is not appropriate for Asian patients in whom, a crease may be undesirable. In selecting surgical methods, it is important to resect a minimal amount of skin-muscle to avoid the adverse effects of ectropion and eyelid retraction.

SUMMARY

Although epiblepharon may resolve with facial growth, surgical correction is needed for cases in which there is significant corneal injury from the lash touch. Surgical management should focus on techniques that are effective, with little chance of complication, and do not create a lower eyelid crease.

Effects of epiblepharon surgery on higher-order aberrations

PURPOSE

To quantify and compare higher-order aberrations (HOAs) in children after epiblepharon surgery.

METHODS

The medical records of children (mean age, 7.3 years [range, 2-13 years]) who underwent surgery for epiblepharon were reviewed retrospectively. Aberrometry was conducted before surgery and at 1 month's and 3 months' follow-up using the Wavefront Analyzer KR-1W. Corneal HOAs in the 4 mm and 6 mm optical zones were compared. Classification of the severity of epiblepharon was based on the degree of cilia touching the cornea and corneal erosion.

RESULTS

A total of 120 eyes of 60 patients were included. Corneal total HOAs in the 4 mm and 6 mm optical zone decreased significantly at 1 and 3 months after surgery (P = 0.001 and 0.000, resp.. in the 4 mm zone; P = 0.006 and 0.006 in the 6 mm zone). Surgery induced a significant reduction of fourth-order aberrations, with decrease of tetrafoil in the 4 mm zone and coma, tetrafoil, and secondary astigmatism in the 6 mm zone 3 months after surgery; the differences were statistically significant (P = 0.038 and 0.006 in the 4 mm zone; P = 0.018 and 0.000 in the 6 mm zone). Although there was no significant association between epiblepharon severity and total HOAs, reduction of corneal staining grade and decrease of total HOAs at 3 months were significantly correlated (P = 0.03 in the 6 mm zone).

CONCLUSIONS

In this patient cohort, total HOAs decreased significantly after epiblepharon surgery. The correlation of reduction of corneal staining grade and decrease of total HOAs may be helpful in deciding the timing of surgery in children who have no specific visual symptoms.

Is it truly necessary to add epicanthoplasty for correction of the epiblepharon?

BACKGROUND

There are many modified variations of the original Hotz procedure for the repair of the epiblepharon. No matter which procedure is used, there must be some factors that may cause recurrence. One of possible causes of these unsatisfactory results can be due to the presence of epicanthal folds (EFs) among the oriental population. It is important to determine whether patients should be repaired with the simple epiblepharon or if it should be combined with epicanthoplasty especially for actively growing children.

METHODS

All the patients were between 4 and 7 years old and had both epiblepharon and EF. The EFs were classified in 3 types, and all patients were operated on with the modified Hotz procedure. A "good" outcome was defined to be no contact between the eyelash and eyeball, and a "fair" outcome was defined to be several eyelashes contact with the eyeball, without any annoying symptoms. A "poor" outcome was defined to be most of the eyelids still in contact with the eyeball, and these patients persistently complain of irritation or keratitis.

RESULTS

The study included 46 lower eyelids of 23 patients (14 females, 9 males; mean age, 5.7 years) who underwent operation. Thirty-five eyelids (76.1%) were assessed to have a "good" outcome, 9 eyelids (19.6%) were assessed to have a "fair" outcome, and 2 eyelids (4.3%) were assessed to have a "poor" outcome.

CONCLUSIONS

We firmly believe that epicanthoplasty is not necessarily performed routinely for all epiblepharon unless there is any specific reason to justify the combined procedure.

The clinical characteristics and surgical outcomes of epiblepharon in korean children: a 9-year experience

Purpose. To examine the demographic characteristics, clinical features, surgical outcomes, and long-term prognoses of epiblepharon in Korean children. Methods. Epiblepharon patients who were followed for ≥ 6 month following surgical correction between January 2005 and December 2013. The patient demographics, clinical features, concomitant disorders, surgical outcomes, and complications were retrospectively reviewed. Results. A total of 768 epiblepharon records were included in the analysis. The mean patient age was 6.55 ± 2.37 years. At presentation, 712 patients (92.8%) complained of typical epiblepharon symptoms. The mean patient age at surgery was 6.95 ± 2.52 years, with 629 patients (81.9%) on the lower lid and 72 patients (9.4%) on the upper lid and 82 patients (10.7%) undergoing surgery on both lids. The eyelid was well everted with no recurrence in 740 patients (96.4%). Conclusion. Epiblepharon frequently occurs in Korean children and is correctable with a simple surgery. Recurrence and serious complications do not occur often, and any suspicions of epiblepharon should be investigated. A thorough ocular examination can lead to a correct diagnosis and timely corrective surgery. Most procedures are successful and prevent secondary complications that often occur with uncorrected epiblepharon.

The effect of epiblepharon surgery on visual acuity and with-the-rule astigmatism in children

Purpose

To evaluate the effect of epiblepharon surgery on visual acuity and with-the-rule astigmatism in children compared to patients without surgical treatment.

Methods

We undertook a retrospective case control study and reviewed the charts of 202 eyes treated with epiblepharon surgery and of 142 eyes without surgery. The surgical procedure for epiblepharon correction used rotating suture techniques. Data regarding age, best corrected visual acuity, and degree of astigmatism were recorded. Baseline and 1-, 3-, 6-, and 12-month postoperative data were collected. The chi-square test, Student's t-test and general linear model analysis for repeated measures were applied.

Results

The mean astigmatism in the surgical group decreased from 1.10 ± 1.02 diopter (D) preoperatively to 0.84 ± 1.05 D at 3 months after surgery (p < 0.05). However, there was no statistically significant difference compared to the non-surgical group during the first year. The general linear model analysis comparing the mean astigmatism between the two groups over time showed a significant group-time interaction (p < 0.05). Within the surgical group, the higher baseline astigmatic subgroup and the 5- to 8-year-old group demonstrated greater cylinder reduction over time. The change in mean visual acuity was not significant in either group.

Conclusions

Significant astigmatic reduction was found after surgical correction in epiblepharon patients. Patients with higher baseline astigmatism exhibited greater astigmatic reduction after epiblepharon surgery. These results suggest that, in order to reduce astigmatism, an epiblepharon operation should be considered in patients with a high level of astigmatism.

Epiblepharon in East asian patients: the singapore experience

PURPOSE

To describe the demographics, presenting symptoms, indications for surgery, and surgical outcomes of epiblepharon correction in a tertiary care hospital in Singapore.

DESIGN

Retrospective review of patients who underwent surgery by 2 surgeons in a referral oculoplastic practice at the National University Health System, Singapore, from 2001 to 2007.

PARTICIPANTS

A total of 108 patients who underwent surgery for clinically significant epiblepharon.

INTERVENTION

Modified Hotz procedure or suture correction for patients in whom conservative treatment failed.

MAIN OUTCOME MEASURES

Comparison of symptoms, keratopathy, and recurrence on follow-up between the 2 procedures.

RESULTS

The mean age of the patients was 9.0 years, with an age range of 0.5 to 68 years. Of the patients, 51.9% were male. The majority were Chinese (n = 102). Seventy-four (68.5%) patients were symptomatic. Eighty-nine patients (82.4%) had keratopathy. In 98 patients (90.7%) both eyes were affected, and the majority of patients (75.0%) had epiblepharon of the lower lids. Initial treatment for the majority was lubricants (n = 71, 65.7%). The main indications for surgery were symptoms and keratopathy, with 37.9% of patients having both, and 44.4% and 15.7% of patients having either keratopathy or symptoms alone, respectively. Surgical correction consisted mostly of a modified Hotz procedure (n = 88, 81.5%), lid-everting sutures (n = 9, 8.3%), and others, including upper lid blepharoplasty with lid crease formation (n = 11, 10.2%). Outcomes were good, with the majority (n = 88, 81.5%) of lids being well corrected. Complications included undercorrection, overcorrection, wound dehiscence, and wound infections.

CONCLUSIONS

Symptomatic epiblepharon, usually associated with keratopathy and commonly seen in children of East Asian descent, often requires surgical intervention with good surgical outcome. Increased awareness among ophthalmologists and pediatricians dealing with this ethnic group and age is emphasized. Contrary to the current practice of expectant observation, definitive surgical management should be considered when symptoms or keratopathy is present.

FINANCIAL DISCLOSURE(S)

The author(s) have no proprietary or commercial interest in any materials discussed in this article.

Changes in astigmatism after surgery for epiblepharon in highly astigmatic children: a controlled study

PURPOSE

To evaluate changes in astigmatism after corrective surgery in highly astigmatic epiblepharon patients compared with nonepiblepharon patients.

METHODS

We retrospectively reviewed the charts of 37 patients with epiblepharon and 35 patients without epiblepharon, but with initial astigmatism > or =2 D. Demographic data and preoperative data for best-corrected visual acuity, degree of astigmatism, and astigmatism axis were obtained. Postoperative data were collected at 1, 3, 6, and 12 months and at 2 years.

RESULTS

The mean age at surgery was 5.1 +/- 1.5 years. The mean amount of cylinder was 3.27 +/- 0.97 D before surgery and 2.62 +/- 1.07 D at 2 years after surgery. Linear mixed measures analysis, which was used to compare the mean cylinder between the epiblepharon and nonepiblepharon groups, showed significant group-time interaction (p < 0.01). Patients who were younger and had greater initial cylinder showed significantly greater decreases in the cylinder during 2 years of follow-up (p < 0.05).

CONCLUSIONS

Significant astigmatic changes were found after surgical correction in epiblepharon patients with 2 D of astigmatism or greater compared with nonepiblepharon patients, and these changes were more significant in patients of younger age and with greater astigmatism. A high prevalence of epiblepharon during the critical period for visual development warrants physician interest in early surgery and visual rehabilitation in highly astigmatic epiblepharon patients.