Epiblepharon in East Asian Patients: The Singapore Experience

Pediatric Thyroid Eye Disease—The Singapore Experience

“…Increased intraorbital pressure in TED may lead to fat prolapse, predisposing to overriding of anterior lamella over the posterior lamella. 24 Lower lid retraction in TED may be involved in the pathogenesis of acquired epiblepharon, 29 as it was seen in 7 out of 8 patients with epiblepharon (87.5%). Lower lid retraction may occur secondary to fibrosis and shortening of the posterior lamella, and since the anterior lamella remains in its normal position, this results in anterior lamella overriding and the subsequent development of an acquired epiblepharon.…”

“…24 This results in eyelashes brushing against the ocular surface, subsequently leading to keratopathy and conjunctivopathy. Epiblepharon is a common condition among East Asians.…”

Modified everting sutures: an alternative treatment for mild to moderate epiblepharon

“…O’Donnell and Collin8 used the Quickert suture technique in patients less than 3 years of age, with persisting symptoms but lash-globe contact present only in downgaze or adduction, or with only few trichiasis lashes in primary position, and found it to be effective in 92% with relief of symptoms and normalisation of lid position. Sundar et al 5 found a good outcome was achieved in 55% and undercorrection in 44% using 5-0 double-armed absorbable suture (Vicryl, polyglactin), but did not mention on the grade of the epiblepharon for which the everting suture technique was used.…”

“…Other options include waiting for the child to grow older and hoping for spontaneous resolution, or waiting for the epiblepharon to worsen to warrant surgical correction. Surgical indications include persistent epiblepharon with symptoms, keratopathy and astigmatism attributed to epiblepharon 5. Surgical approaches include the lid crease and capsulopalpebral fascia repair,6 modified Hotz procedure,5 7–9 Quickert everting suture technique10 and cilia rotational suture with minimal skin excision 4 9…”

Non-incisional eyelid everting suture technique for treating lower lid epiblepharon

“…Hayasaka et al 13 reported a 24.3% (36/148 eyes) recurrence rate with 6 months of follow-up. A comparison study between a modified Hotz surgery (88 patients) and everting suture technique (9 patients) for epiblepharon reported a success rate of 83% and 55%, respectively 14. Neither studies had a classification system to assess the severity of epiblepharon 13 14.…”