Comparing the Effectiveness of Two Surgical Techniques for Treating Lower Lid Epiblepharon in Children: A Randomized Controlled Trial

Abstract

A multicenter randomized controlled trial was conducted to compare the effectiveness of incisional and nonincisional surgical techniques for treating lower lid epiblepharon in children. The study included 89 eyes from 50 children aged 3–15 years (mean, 7.5 ± 2.4 years) with clinically significant moderate lower lid epiblepharon. Patients were randomly assigned to either incisional (modified Hotz procedure with lid margin splitting; 45 eyes of 25 patients) or nonincisional (44 eyes of 25 patients) surgery groups. Treatment outcomes were evaluated 6 months after surgery and classified into three grades: well-corrected, no ciliary touch, and superficial keratitis; under-corrected, ciliary touch, and superficial keratitis; and over-corrected, eyelid ectropion, and insufficient eyelid closure. Changes in astigmatism were compared between the two techniques after surgery. Incisional surgery provided a significantly higher percentage (77.8%) of well-corrected treatment results (P = 0.026; odds ratio, 2.88; 95% confidence interval, 1.07–8.22) than nonincisional surgery (55.4%). The mean change in astigmatism pre and post surgery was − 0.24 ± 0.42 and − 0.01 ± 0.47 D in the incisional and nonincisional surgery groups, respectively. The improvement in astigmatism 6 months after surgery was significantly higher in the incisional surgery group than in the nonincisional surgery group (P = 0.008). The incisional surgical treatment for epiblepharon in children resulted in a higher number of well-corrected patients, indicating an absence of both ciliary touch and superficial keratitis as well as statistically significant improvements in astigmatism correction.