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Epiblepharon |
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Some children have lower eyelids
with “too much skin” given the size of their
face, and this causes
their eyelashes to roll inwards. This
is termed “epiblepharon.” When the
lashes roll inwards enough, they rub against the cornea and cause irritation. Because the lashes are soft, many children
with epiblepharon have no symptoms.
However, those with symptoms will typically have a clear/white discharge,
excessive tearing, and (sometimes) light sensitivity.
In severe cases, these symptoms can be significant and, given
enough time, the lashes rubbing against the cornea can cause permanent changes to
the cornea.
Most children with epiblepharon outgrow it – as their facial dimensions change,
the lashes begin to rotate into a normal position (pointing outwards).
This development occurs in a temporal to nasal direction (from
the ear side towards the nose side).
While waiting for natural resolution, the use of lubricating ointments (such as
ophthalmic bacitracin) can minimize the symptoms.
If a child has epiblepharon beyond the age of 2 or 2 ½ years, it will
not likely resolve on its own.
In these cases, surgery is indicated – a strip of excess skin (and the muscle under
it) is removed from under the lids and, when the skin is sutured back together,
the eyelashes roll outwards into a normal position.
Initially, the incision site may be noticeable but this dissipates
over the next several months and (in my experience) the cosmetic results have been
excellent – it’s hard to know that anything was done.
In addition to scarring (there is no such thing as cutting without scarring
on some level), the risks
include a need for reoperation (if too much or too little
skin is removed), infection, bleeding, and vision loss/damage
(though this is very, very rare).
The alternative to surgery is either continued lubrication or no surgery.
Without surgery, epiblepharon will not resolve on its own after a certain
age and there is a risk of vision loss/damage from corneal scarring. |
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