Lower Eyelid Epiblepharon Associated with Lower Eyelid Retraction

Abstract

PurposeTo describe a series of patients with lower eyelid epiblepharon associated with lower eyelid retraction.MethodsWe retrospectively reviewed the medical records of patients who underwent surgery for lower eyelid retraction, epiblepharon, or thyroid-associated ophthalmopathy (TAO) between October 1999 and March 2007. Patients with both lower eyelid retraction and epiblepharon on preoperative examination were included in this study.ResultsTwenty-seven eyelids of 20 patients with both lower eyelid retraction and epiblepharon were enrolled. The underlying causes of lower eyelid retraction included congenital retraction (seven eyelids), congenital fibrosis of the extraocular muscles (CFEOM; seven eyelids), TAO (seven eyelids), post-operative cicatricial retraction (five eyelids), and facial nerve palsy (one eyelid). Eight of 27 eyelids were successfully corrected after the repair of retraction without the repair of epiblepharon, regardless of the cause of lower eyelid retraction. Another four eyelids with epiblepharon associated with TAO resolved after only orbital decompression. Cilia-everting sutures were additionally applied for epiblepharon in another 14 eyelids, 12 of which did not require the excision of a skin fold or the orbicularis muscles. Only one eyelid with mild retraction and epiblepharon underwent simple epiblepharon repair. Recurrence of retraction or epiblepharon developed in three eyelids during follow-up.ConclusionsIn cases with both lower eyelid retraction and epiblepharon, the retraction should be repaired first, and then the epiblepharon can be corrected selectively according to the severity of the case.

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.…”

Outcomes of Various Surgical Procedures on Acquired Lower Eyelid Epiblepharon in Thyroid Associated Ophthalmopathy

“…Fifty three TAO patients were diagnosed as an acquired lower eyelid epiblepharon, and 25 eyelids of 17 patients underwent surgical treatment; 7 eyelids of 4 patients from our previous report were also included [ 8 ]. Three patients were male and 14 patients were female with mean age of 38.3 years (SD, ±12.7 years).…”

“…Surgical management of TAO patients was generally performed in a serial order of orbital decompression, strabismus surgery, retraction repair, and eyelid surgery. As for an acquired lower eyelid epiblepharon in TAO patients, this principle should be also followed and epiblepharons were managed by orbital decompression first if there were accompanied exophthalmos or compressive optic neuropathy; it was reported that orbital decompression in TAO patients could also improve lower eyelid retraction and epiblepharon [ 8 ]. If epiblepharon does not resolve after orbital decompression and lower eyelid retraction was accompanied, then, retraction repair should be performed.…”

“…Chang et al [ 7 ] reported only 1 patient without follow-up. Our group previously reported the surgical results of four TAO patients with both lower eyelid retraction and epiblepharon [ 8 ]. These two reports said that acquired lower eyelid epiblepharon of TAO could be resolved secondarily after orbital decompression or retraction repair.…”

Eyelids, Eyelashes, and Eyebrows

“…The condition is usually not related to other eyelid abnormalities (Sung et al 2010). Sung et al (2010) described one rare occurrence of congenital epiblepharon associated with congenital eyelid retraction.…”