• astigmatism
• cornea
• epiblepharon
• keratoconus
• topographic modeling system

• funding to report

• Humans
• Child
• Cross-Sectional Studies
• Male
• Female
• Prevalence
• China/epidemiology
• Eyelids/abnormalities
• Body Mass Index
• Refractive Errors/epidemiology
• Visual Acuity/physiology
• Refraction, Ocular/physiology
• Eye Abnormalities/epidemiology
• Eye Abnormalities/diagnosis
• East Asian People
• Eyelid Diseases/congenital

• Humans
• Strabismus/surgery
• Strabismus/physiopathology
• Female
• Male
• Child
• Retrospective Studies
• Visual Acuity/physiology
• Vision, Binocular/physiology
• Oculomotor Muscles/surgery
• Oculomotor Muscles/physiopathology
• Child, Preschool
• Eyelids/abnormalities
• Eyelids/surgery
• Eyelids/physiopathology
• Ophthalmologic Surgical Procedures/methods
• Follow-Up Studies
• Depth Perception/physiology
• Eye Movements/physiology
• Postoperative Period
• Eyelid Diseases/congenital

• 2-octyl cyanoacrylate
• epiblepharon
• personal satisfaction
• tissue adhesive

• TYAFGH-E-112051 Taoyuan Armed Forces General Hospital

• Chinese children
• Epiblepharon
• Minimal epicanthoplasty
• Thermal contraction

• Epiblepharon
• High-frequency radio wave electrocautery
• Hotz operation

• Chinese children
• modified skin re-draping epicanthoplasty
• recurrent epiblepharon

In children, it is common to see failure and recurrence in the correction of epiblepharon and to have reoperation due to obvious irritation symptoms and corneal injury.

To explore the causes of failure and recurrence after epiblepharon correction in children, to remove accurately redundant epiblepharon and orbicularis oculi muscle in patients via the cilia-everting suture technique combined with lid margin splitting in some patients due to inverted lashes in the medial part of the eyelid, and to observe the therapeutic effect.

From 2015 to 2019, in the Outpatient Department of Ophthalmology of Beijing Tongren Hospital, 22 children (40 eyes) with epiblepharon, aged 5-12 years, were treated due to correction failure and recurrence. Fourteen patients (28 eyes) underwent the full-thickness everting suture technique, and eight patients (16 eyes) underwent incisional surgery. They were treated by reviewing the previous surgical methods and observing epiblepharon, eyelash direction, and corneal injury. During reoperation, a subciliary incision was made 1 mm below the inferior lash line. Incisional surgery for the lower eyelid was used to remove accurately redundant epiblepharon and part of the pretarsal orbicularis muscle. Subcutaneous tissue and the orbicularis muscle of the upper skin-muscle flap were anchored to the anterior fascia of the tarsal plate by rotational sutures. Lid margin splitting was used only for patients who had seriously inverted lashes located in the medial part of the eyelid. All patients were followed for 6-12 mo after reoperation to observe the lower eyelid position, skin incision, eyelash direction, corneal damage, and recurrence.

After reoperation, all the patients were corrected. Photophobia, rubbing the eye, winking, and tearing disappeared. There was no lower eyelid entropion, ectropion, or retraction. There was no obvious sunken scar or lower eyelid crease. The eyelashes were far away from the cornea, and when the patients looked down, the eyelashes on the lower eyelid did not contact the cornea or conjunctiva. The corneal injuries were repaired. Follow-up observation for 6 mo showed no recurrence of epiblepharon.

The type of suture method, the failure to remove accurately redundant skin and orbicularis muscle, the lack of cilia rotational suture use, and excessive reverse growth of eyelashes are the main causes of failure and recurrence after epiblepharon correction in children.

• Epiblepharon failure recurrence
• Children
• Reoperation effect
• Epiblepharon correction
• Irritation symptom

To identify an appropriate surgical indication of epiblepharon by comparing keratopathy and astigmatism outcomes after surgical and medical treatments for epiblepharon in Asian children.

Children diagnosed with epiblepharon (n = 82, age 5.93 ± 2.76 years) with >6 months of follow-up were enrolled. The clinical presentations and cycloplegic refractive status at the baseline and 3 and 6 months after treatment were compared between surgical (91 eyes from 47 children) and nonsurgical (67 eyes from 35 children) groups. The refractive and keratometric astigmatism at each time point were evaluated with vector analysis methods. For Thibos and Horner's method, the astigmatic power vector was decomposed into horizontal and oblique meridians (J₀ and J₄₅). However, the treatment-induced astigmatism (TIA) vectors were calculated by Alpins' method and depicted by the AstigMATIC software.

In the surgical and nonsurgical groups, the baseline astigmatism magnitude was similar (2.22 ± 1.39 and 2.26 ± 1.46 D, p = 0.87). The rate of complete resolution of keratopathy at 6 months was 71.4% and 11.5%. The astigmatism magnitude in the surgical group differed among baseline and 3 months (2.25 ± 1.23 D) and 6 months postoperatively (1.97 ± 1.28 D) (p = 0.001). Power vector analyses confirmed a nuanced against-the-rule shift in the surgical group. This trend was especially observed in the subgroup of baseline astigmatism >2.0 D. However, the difference in the astigmatism magnitude between surgical and nonsurgical groups, even in highly astigmatic children, was not significant at 6 months.

The improvement of keratopathy in the surgical group was greater than that in the nonsurgical group in consideration of the more advanced severity in the surgery group at baseline. Decreased with-the-rule astigmatism can be observed at 6 months postoperatively, particularly among those with greater baseline astigmatism. However, the amount of change is small, and the outcome does not differ significantly from the nonsurgical treatment. Therefore, surgical indications should majorly base on the severity of symptoms and keratopathy.

• Eye Lids
• Treatment Surgery

• eyelids
• treatment surgery

• Corneal epithelial permeability
• Ethnicity
• Fluorometry
• Race
• Shear stress