An Asian Patient with Epiblepharon

Have you ever encountered someone of East Asian descent with misdirected eyelashes that seem to cause discomfort? This might be an indication of a common eyelid anomaly called epiblepharon. In this condition, the eyelashes are misdirected, potentially leading to irritation and corneal issues if left untreated. As we embark on this exploration of epiblepharon, you will learn about its various aspects, including its epiblepharon definition, symptoms, diagnosis, treatment options, and long-term management.

Key Takeaways

  • Epiblepharon is an eyelid anomaly that can be either congenital or acquired.
  • Symptoms of epiblepharon may include foreign body sensation, tearing, redness and itching.
  • Treatment options for epiblepharon vary from conservative management to different surgical techniques to avoid potential complications such as corneal infections and scarring.

Defining Epiblepharon

Epiblepharon is an eyelid anomaly that can be either congenital or acquired, affecting the eyelid margin and causing eyelashes to be misdirected. This condition often appears in East Asian populations, especially among children and young adults with weak or nonexistent upper eyelid creases.

The lower eyelid retractors and the anterior lamella fail to adhere in epiblepharon, resulting in the skin and muscle rolling upwards. This is known as an anatomical abnormality. What differentiates congenital from acquired epiblepharon? And is it possible for it to affect both the lower and upper eyelids?

Congenital vs. Acquired Epiblepharon

Congenital epiblepharon is far more common than its acquired counterpart due to a lack of attachment of eyelid retractors. On the other hand, acquired epiblepharon may be caused by:

  • trauma to the eyelid
  • scarring from previous surgery
  • eyelid inflammation

In some cases, reconstructive surgery may be necessary to correct the condition.

On the other hand, acquired epiblepharon may present with clinical manifestations of an underlying orbital disorder, such as thyroid eye disease, orbital tumour, or inflammatory disease. Upper epiblepharon affects the upper lid, also known as the upper eyelid. It is characterized by misdirected medial eyelashes that cause intermittent corneal-conjunctival contact in upward and inward gazes.

Congenital and acquired epiblepharon can lead to significant discomfort and potential complications if left untreated. However, it’s worth noting that many people with congenital epiblepharon can tolerate the condition quite well for years. The author has encountered numerous patients who have reached their 20s or even 30s before deciding to seek treatment for the condition.

Lower vs. Upper Eyelid Involvement

Lower lid epiblepharon can affect both lower and upper eyelids, with the lower eyelid being more commonly involved. The abnormal congenital horizontal fold in the eyelid causes misdirected eyelashes and potential irritation. As facial bones develop and grow, the condition may resolve independently, particularly in patients aged between 4 to 7 years.

Despite its higher prevalence in the lower eyelid, epiblepharon in the upper eyelid can still induce discomfort and potential corneal problems. Hence, early identification and intervention is necessary, irrespective of the affected eyelid.

Symptoms and Complications

Epiblepharon can present with the following symptoms:

  • Foreign body sensation
  • Excessive tearing
  • Redness
  • Itching

These significant symptoms can be particularly distressing for young children, including those of Asian or Hispanic descent, and interestingly, it has been observed to be quite common in the indigenous population of Saskatchewan. This often leads to frequent rubbing of the eyes, exacerbating the condition.

Neglecting these symptoms can lead to escalated complications like corneal infections and scarring. Let’s examine the foreign body sensation and the possible corneal repercussions of untreated epiblepharon.

Foreign Body Sensation

The foreign body sensation experienced by those with epiblepharon can cause significant discomfort, leading to frequent blinking and rubbing of the eyes. In severe cases, surgical intervention may be necessary to correct the condition and prevent corneal infections and scarring. However, lubricating eye drops and conservative management may temporarily relieve the foreign body sensation in milder cases.

While the foreign body sensation may appear insignificant, it can cause considerable discomfort and disrupt daily life. Hence, pursuing suitable treatment to control this symptom and avert further complications is crucial.

Corneal Infections and Scarring

Untreated epiblepharon can lead to corneal infections, such as superficial punctate keratitis, corneal ulcers, and other corneal infections. These infections can cause scarring on the cornea, potentially affecting vision and leading to long-term complications.

Preventing corneal infections and scarring necessitates early intervention in cases of epiblepharon, either through conservative management or surgical procedures if required. Prompt action can alleviate symptoms and safeguard the eyes from possible harm.

Diagnosis and Assessment

Diagnosing epiblepharon involves a clinical evaluation, during which eyelashes abutting the cornea and conjunctiva in any gaze indicate the condition. Fluorescein staining and slit lamp photography may be used to assess the extent and severity of keratopathy.

Once the diagnosis is established, the severity of epiblepharon can be graded and differentiated from other eyelid abnormalities.

Severity Grading

Severity grading for epiblepharon is determined by factors such as eyelid skin fold, lash-corneal touch, and keratopathy. The severity grading can be classified according to the height of the horizontal skin fold on the lower lid. Understanding the severity of epiblepharon helps determine the appropriate treatment approach, ranging from conservative management to surgical intervention.

With a precise assessment of the condition’s severity, healthcare professionals can customize treatment plans that cater to each patient’s unique needs, thereby ensuring the best possible outcomes.

Differential Diagnosis

Differential diagnosis for epiblepharon includes:

  • Entropion
  • Ectropion
  • Distichiasis
  • Trichiasis

It is essential to distinguish epiblepharon from these other eyelid abnormalities to ensure appropriate treatment and management.

A differential diagnosis enables healthcare professionals to eliminate other potential conditions and validate epiblepharon’s presence. This facilitates targeted treatment to ease symptoms and prevent complications.

One of the main differentiating features of epiblepharon from entropion is the tendency for epiblepharon to involve the medial aspect of the lower eyelid.

Treatment Options

Treatment options for epiblepharon range from conservative management, such as lubricating eye drops, to various surgical techniques. The treatment choice depends on the severity of the condition and the presence of associated keratopathy.

Conservative management may suffice in milder cases in providing temporary relief, while more severe cases may require surgical intervention.

Lubricating Eye Drops and Conservative Management

In mild cases of epiblepharon, treatment options include:

  • Lubricating eye drops and conservative management for temporary relief from symptoms
  • Topical lubricants to alleviate dryness and discomfort
  • Adequate follow-up care to monitor the condition until it resolves

In some cases, Botulinum toxin type A (BoNT-A) injections may be used to rectify symptomatic epiblepharon in patients younger than two years of age, with effects typically lasting up to six months.

While conservative management may not provide a permanent solution for epiblepharon, it can significantly ease the discomfort for patients with milder symptoms, enabling them to continue their daily activities painlessly.

Surgical Techniques

Various surgical techniques can correct epiblepharon, such as eyelid everting sutures, orbicularis oculi muscle and skin excision, and transconjunctival approach. The rotating suture technique involves placing sutures to ensure the outward rotation of the eyelashes while closing the wound. The Hotz procedure has been modified. It involves the removal of a redundant skin ellipse, primarily from the medial part of the lower eyelid.

The transconjunctival approach is a procedure for correcting lower eyelid retraction that offers several benefits:

  • It avoids external incisions, resulting in minimal risk of scarring.
  • It provides long-lasting relief from the condition.
  • It can be tailored to the patient’s individual needs.
  • It helps prevent potential complications associated with epiblepharon.

Prognosis and Post-Treatment Care

Prognosis for epiblepharon is generally good after treatment, with low recurrence rates and minimal need for revision surgeries.

Still, regular eye examinations and post-treatment care to monitor the condition are crucial to secure optimal results and prevent possible complications.

Recurrence Rate and Revision Surgeries

Recurrence rates for epiblepharon are low, with no recurrence observed in 740 patients (96.4%). However, some cases may require revision surgeries for optimal results, particularly if the initial surgery proves to be ineffective or if the epiblepharon recurs.

By monitoring the condition and promptly addressing any recurrence or complications, patients can anticipate a positive prognosis and upkeep of their eye health.

Long-term Management

Long-term management of epiblepharon may involve regular eye exams and monitoring for potential complications. In many cases, children may outgrow the condition as their facial structures develop, and surgery may not be necessary.

However, if the condition does not resolve spontaneously and the eyelashes persist in irritating or scratching the cornea, surgical intervention may be necessary to rectify it.

Regular eye check-ups and early intervention in case of any complications can assure the best possible outcomes in managing epiblepharon for patients.


Throughout this exploration of epiblepharon, we have discussed its definition, symptoms, diagnosis, treatment options, and long-term management. Epiblepharon is an eyelid anomaly primarily affecting East Asian populations, with the potential to cause discomfort and corneal complications if left untreated. Treatment options range from conservative management to surgical intervention, depending on the severity of the condition. With appropriate care and management, the prognosis for epiblepharon is generally favourable, allowing patients to maintain their eye health and quality of life.

It is important to remember that early detection and intervention are crucial in managing epiblepharon and preventing potential complications. Patients can protect their eyes and ensure a bright future by staying informed and proactive in addressing this condition.

Frequently Asked Questions

What causes epiblepharon?

Epiblepharon is a congenital condition caused by the absent or poor attachment of the deep muscles inside the eyelid to the front of the eyelid. It is more common in Asian or Hispanic children and can occur in one or both eyes. This condition can cause the eyelid to turn outwards, resulting in the eyelashes rubbing against the eye. This can cause irritation, redness, and tearing. In some cases, epiblepharon can also cause vision problems.

How do you treat epiblepharon?

Epiblepharon can typically be treated with eye drops and ointments, but surgery may sometimes be necessary if the condition does not improve. Surgery typically involves an incision being made under the eyelashes on the lower eyelid to remove any extra roll of skin.

How do you diagnose epiblepharon?

Epiblepharon can be diagnosed through careful clinical observation as it is characterized by eyelashes touching the cornea. If no actual in-turning of the eyelid margin is seen and the lid margin is pulled downward, epiblepharon can be ruled out.

Do babies outgrow epiblepharon?

Fortunately, epiblepharon is usually a temporary condition and most babies will outgrow it as their facial bones, skin and muscles grow. However, some children may need surgery to correct the condition.

What are the symptoms of epiblepharon?

Epiblepharon can cause foreign body sensation, redness, irritation, tearing and photophobia when the eyelashes rub against the front of the eye. In more severe cases, it may be associated with keratopathy or keratitis.


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  3. “Epiblepharon: A Review of Current Concepts in Management” URL:
  4. “Epiblepharon: A Rare Eyelid Disorder and its Management” URL:
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Photo graph of Dr. Conlon operating with loops on.

Dr. M. Ronan Conlon started his career in the field of ophthalmology at the same time as the development of refractive eye surgery in Canada. In 1996, he brought laser technology to Canada from Germany, which allowed him to perform laser eye surgery before it was available in the United States. With the establishment of the Conlon Eye Institute, Dr. Conlon has performed more than 40,000 refractive procedures and has advanced his expertise in LASIK and refractive cataract surgery.


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