Surgical correction for lower lid epiblepharon in Asians

Abstract

Background/aims: Epiblepharon is a congenital lid anomaly in which a fold of skin and underlying orbicularis muscle push the lashes against the eyeball. It is important to get a good lash eversion effect without forming a prominent lid crease in Asian patients. The surgical effect of this rotating suture technique was evaluated.

Methods: Surgical correction for epiblepharon was performed on 197 patients and the results analysed in 169 patients who had been followed for 1 month or more. After subciliary incision, several buried 8-0 nylon sutures were placed to allow adhesion between the tarsal plate and the subcutaneous tissue of the upper skin flap with minimal resection of pretarsal orbicularis and redundant skin.

Results: 156 patients (92.3%) showed satisfactory results during 7.1 months of average follow up. Reoperation was performed only on two patients out of 13 because of mildness of symptoms and signs. Complications were minimal including suture abscesses in four patients and wound dehiscence in one.

Conclusion: The rotating suture technique was very effective in repairing epiblepharon without forming a prominent lower eyelid crease.

Figure 1

This patient required removal the lower eyelid crease which occurred as a result of epiblepharon surgery. He was displeased with his cosmetic result even though no cilia touched his cornea.

Figure 2

Surgical techniques. (A) Note the vertical direction of the eyelashes. (B, C) Buried 8-0 nylon sutures are placed to allow adhesions to form between the tarsal plate and the subcutaneous tissue of the upper skin flap. (D) Cross section demonstrates suture in its proper position. (E) Minimal amounts of redundant skin and orbicularis muscle are removed to avoid ectropion or lower eyelid retraction. In both ends of the incision, the dogears are removed with triangular skin excision. (F) After meticulous haemostasis, the skin is closed with a running 6-0 fast absorbing gut suture.

Figure 3

This patient had epiblepharon surgery 10 years ago, and she has visible scars and lower eyelid retraction because too much skin had been taken at the time of surgery.