Surgical correction of recurrent epiblepharon in Chinese children using modified skin re-draping epicanthoplasty

Abstract

Aim: To evaluate the clinical efficacy of the modified skin re-draping epicanthoplasty procedure for correction of recurrent lower lid epiblepharon in Chinese children.

Methods: From 2016 to 2018, 18 children (10 males and 8 females, average age 6.2±1.7y; 30 eyes) with recurrent epiblepharon who attended Beijing Children's Hospital were included in the study. All the children had undergone lower eyelid surgery for epiblepharon. Surgical design included using an additional incision along the upper palpebral margin, to avoid vertical scarring on the upper lid. The re-draping method was used to correct recurrent epiblepharon. Follow-up ranged from 3 to 24mo. Postoperative surgical outcomes, complications, and subjective satisfaction were evaluated.

Results: Complete correction of cilia touching the cornea was observed in all patients during an average follow-up of 7.1mo. No "dog ears" or obvious scars were formed after surgery. All parents were satisfied with the cosmetic results and none complained. Mean astigmatism decreased from 2.39±0.79 diopter (D) preoperatively to 2.19±0.79 D at 6mo after surgery; however, the difference was not significant. Best-corrected visual acuity improved, although the change in mean visual acuity was not significant. No recurrence occurred during the follow-up period.

Conclusion: This surgical modified skin re-draping technique is effective and highly satisfactory for correction of recurrent epiblepharon. The approach is characterized by a simple design, a straightforward procedure, inconspicuous scarring, and good postoperative appearance.

Keywords: Chinese children; modified skin re-draping epicanthoplasty; recurrent epiblepharon.

Figure 1. Operation design and procedure

A: Preoperative touching of the cornea by cilia. B: Prominent scarring was exposed when the skin was tracked downwards. C: Incision design: Point a was the projected position of point b on the skin surface. Point b was marked 2 mm medial from the lacrimal lake. By pulling the nose skin in the medial direction, point c was the end of supraciliary line along the ciliary margins, extending from point b, which was 3 mm above the upper ciliary margins and the length of bc was approximately 5 mm. Point d was marked around the lacrimal punctum in the lower eyelid. D: The pretarsal orbicularis muscle was excised to expose the medial epicanthus tendon after the skin incision. E: The abnormal skin tension from the medial canthus transfers to a subciliary incision. The abc flap tracked downwards spontaneously. F: Status after removal of the dense fibrous tissue and abnormal orbicularis oculi muscle above the medial canthal tendon was completed. The eye lash and the scar were immediately corrected. There was significant improvement of deformation of the lower eyelid compared with the preoperative status.

Figure 2. A comparative photograph of a five-year-old boy who underwent the described procedure

A: Pre-operation; B: 4mo post-operation.

Figure 3. A comparative photograph of a seven-year-old boy who underwent the described procedure

A: Pre-operation; B: 4mo post-operation.