Eyelash inversion in epiblepharon: Is it caused by redundant skin?

Abstract

Purpose: To evaluate the effect of redundant lower eyelid skin on the eyelash direction in epiblepharon.

Materials and methods: Asian patients with epiblepharon participated in this study. The lower eyelid skin was pulled downward in the upright position with the extent just to detach from eyelash roots, and the direction of the eyelashes was examined. These evaluations were repeated before surgery while the patients were lying supine under general anesthesia.

Results: The study included 41 lower eyelids of 25 patients (17 females, 8 males, average age; 5.6 years, 16 cases bilateral, 9 unilateral). In the upright position, without downward traction of the skin, the eyelashes were vertically positioned and touching the cornea. The redundant skin touched only the eyelash roots and had minimal contribution to eyelash inversion. With downward skin traction, there was no significant change in the eyelash direction. In the spine position, the eyelashes were touching the cornea, and there was marked redundant skin that was pushing the eyelashes inward. With downward skin traction, there was no significant change.

Conclusions: The direction of lower eyelashes in patients with epiblepharon was less influenced by lower eyelid skin redundancy than previously considered. The redundant skin is only a possible aggravating factor to epiblepharon.

Keywords: epiblepharon; eyelash; skin redundancy; upright.

Figure 1

A) A 3-year-old girl. Upright position without downward traction of the skin. The eyelashes are directed vertically and rub on the cornea. The redundant skin only touches the eyelash roots and therefore it seems to have a minimal contributing role in eyelash inversion. B) Upright position with downward traction of the skin. The direction of the eyelashes is not changed significantly, and they are still directed to the globe.

Figure 2

A) The same 3-year-old girl. Spine position during general anesthesia without downward traction of the skin. The eyelashes are directed toward the cornea. More redundant skin is observed in the lower eyelid than in the upright position (Figure 1A) and seems to have more influence of eyelash direction. B) Spine position during general anesthesia with downward traction of the skin. The direction of the eyelashes has not changed significantly compared with the upright position (Figure 1B).

Figure 3

A diagram of epiblepharon. The eyelash is always directed upright, irrespective of skin redundancy. Abbreviations: AL-LER, anterior layer of lower eyelid retractors; IOM, inferior oblique muscle; IRM, inferior rectus muscle; LL, Lockwood’s ligament; OS, orbital septum; OOM, orbicularis oculi muscle; PL-LER, posterior layer of lower eyelid retractors; RS, redundant skin; SMFT, submuscular fibrous tissue.