Epiblepharon is most common in Asian children. In this condition, the lower eyelid pretarsal muscle and skin ride above the lower eyelid margin to form a horizontal fold of tissue, causing the cilia to assume a vertical position (Fig 10-9). Pathophysiologically, this condition results from a deficiency in the attachment of the lower eyelid retractors (capsulopalpebral fascia) to the skin.
The cilia often do not touch the cornea except in downgaze, and this rarely causes corneal staining. Epiblepharon may not require surgical treatment, as it tends to diminish with maturation of the facial bones. However, it occasionally results in acute or chronic corneal epithelial irritation; in that case, repair is performed by excision of the excess skin and pretarsal orbicularis muscle combined with placement of marginal rotation sutures.
Figure 10-9 Bilateral lower eyelid epiblepharon with persistent corneal irritation.
(Courtesy of Cat N. Burkat, MD.)
Excerpted from BCSC 2020-2021 series: Section 10 - Glaucoma. For more information and to purchase the entire series, please visit https://www.aao.org/bcsc.