- Often lashes do not touch ocular surface.
- Children often tolerate mild lash to cornea touch.
- Tends to decrease with growth of the face and development of the nasal bridge
- Therapy should be guided by patient symptoms and corneal health.
- Ocular lubrication with tear drops daily
- To avoid amblyopia, do not treat a child aggressively with ointment.
- If mechanical keratopathy occurs due to lash touch, might require surgical correction
- Mostly performed bilaterally
- Patient discomfort might be an indication for surgery.
- Many surgical techniques has been described, but most focus on tightening the lower lid retractors and excising an ellipse of skin and orbicularis oculi muscle.
- Small risk of cicatricial eyelid retraction or ectropion
- Tarsal fixation sutures and lash rotational sutures without an incision are also popular.
- 5-0 or 6-0 chromic full-thickness mattress sutures (similar to Quickert sutures) placed at the lower eyelid crease about 2–3 mm inferior to the lashes
- If a prominent epicanthal fold is present, excision or incision of the orbicularis and fibrous tissue beneath the fold might help prevent recurrence.
- Thermal cauterization of the tarsus and lower lid retractors without lash rotating sutures has been described.
Other management considerations
Botulinum toxin A and hyaluronic acid gels have recently been used in the management of epiblepharon, but surgery is the preferred treatment.
Unless there is symptomatic or significant corneal damage, conservative management is recommended.