Epiblepharon is a condition in which the eyelid pretarsal muscle and skin ride above the eyelid margin to form a horizontal fold of tissue that causes the cilia to assume a vertical position. It can involve either the upper or lower eyelid, but is most commonly seen involving the lower eyelid.
It is congenital.
It occurs most commonly in Asian or Hispanic children and can be bilateral.
Diagnosis is based on clinical exam findings. A horizontal fold of skin and hypertrophic orbicularis muscle override the eyelid margin, obscuring the eyelashes and pushing them towards the ocular surface. With the fold of tissue gently moved away, the eyelid margin is itself in a normal position against the globe, which distinguishes it from eyelid margin entropion.
Histopathology has demonstrated that the preseptal orbicularis muscle is often hypertrophic, and overrides over the pretrial orbicularis muscle, causing the tissue rotation.
Epiblepharon is often asymptomatic; however can be associated with foreign body sensation, redness, irritation, and tearing of the eyes. Occasionally, it may be associated with keratitis. Symptoms may be more noticeable when the child is looking downwards (such as reading at school) as this exacerbates the inward rotation of the lid and lashes.
It is commonly confused with entropion, however, the eyelid margin itself is not rotated toward the cornea.
Surgery to remove a strip of skin and orbicularis from the lid margin may be necessary occasionally.
- American Academy of Ophthalmology. Oculoplastics/Orbit: Epiblepharon Practicing Ophthalmologists Learning System, 2017 - 2019 San Francisco: American Academy of Ophthalmology, 2017.
- Skuta GL, et al. Basic and Clinical Science Course: Section 7. 2013-2014. American Academy of Ophthalmology.
- Murray PI, et al. Albert & Jakoblec’s Principles & Practice of Ophthalmology. 3rd Ed. 2000. W.B. Saunders Company. Elsevier, Inc. Chapter 244: 3217-3227.
- Olitsky SE, Hug D, Plummer LS, Stass-Isern M. Nelson Textbook of Pediatrics. Abnormalities of the Lids. Ch. 616: 2163-2165.