Bilateral Epiblepharon

An 11-month-old infant was referred by his pediatrician for possible surgical correction of a bilateral entropion. The mother stated that her son's lashes appear to turn in on occasion; however, he never rubbed his eyes, the eyes were not red, and no discharge or drainage was noted.

Leonid Skorin, Jr, DO, of Albert Lea, Minn, diagnosed bilateral epiblepharon. This congenital condition appears as an extra horizontal fold of skin across the lower eyelid, which forces the lashes against the cornea. It is often seen in Asian persons and may be familial. Epiblepharon frequently resolves on its own, with the differential growth of the facial bones. Surgical correction with tarsal fixation of Hotz is required only when the patient has keratitis and compromised corneal integrity. An elliptical excision of the orbicularis muscle is performed, and the skin edges are reapproximated at the level of the inferior border of the tarsal plate. The procedure helps create a new skin crease and relieves a secondary entropion.

For patients without symptoms, a watch and wait approach is appropriate. After a thorough discussion of the condition with the mother, she decided to simply monitor the infant for any eye irritation. The infant has remained asymptomatic.