Relationship between Palpebral Fissure Height and Corneal Astigmatism of Epiblepharon

PURPOSE: To study the effect of plapebral fissure height on astigmatism in epiblepharon patients. METHODS: The study consisted of 68 eyes of 34 patients who were diagnosed with epiblepharon and 88 eyes of 44 patients who had normal eyelids from September 2012 to July 2013. Data on palpebral fissure height and refractive errors were compared between the epiblepharon group and the control group. Epiblepharon patients were further divided into two subgroups depending on the degree of preoperative corneal erosion in order to study the effects of corneal erosion on corneal astigmatism. RESULTS: The mean age was 5.6 ± 2.2 years in the epiblepharon group and 6.1 ± 1.5 years in the control group (p = 0.339). The mean astigmatism was 2.28 ± 1.54 D in the epiblepharon group and 0.91 ± 1.07 D in the control group. The epiblepharon group showed higher astigmatism than the control group (p < 0.001). The mean palepebral fissure height was 6.70 ± 1.19 mm in the epiblepharon group and 7.63 ± 1.06 mm in the control group. The epiblepharon group exhibited smaller palpebral fissure height than the control group (p < 0.001). In the palpebral fissure height subgroups of the epiblepharon group, the <7.0 mm group showed higher astigmatism than the ≥7.0 mm group (p = 0.026). Higher astigmatism was associated with smaller palpebral fissure height (p = 0.022). CONCLUSIONS: Patients with epiblepharon had significantly higher corneal astigmatism, and higher astigmatism was associated with smaller palpebral fissure height.

Surgical Outcome of Minimal Resection with Full Thickness Rotating Suture Technique for Lower Lid Epiblepharon

PURPOSE: To introduce the minimal skin and orbicularis oculi muscle resection with the full thickness rotating suture technique for lower lid epiblepharon and to assess its surgical outcome. METHODS: A retrospective review of medical records was performed on lower lid epiblepharon patients who were followed for more than 6 months after surgical correction performed between January 2004 and December 2015. All surgeries were performed by one surgeon using minimal skin and orbicularis oculi muscle resection and the full thickness rotating suture technique for lower lid epiblepharon correction. RESULTS: A total of 943 lower lid epiblepharon patients (403 male, 540 female) were included in the analysis. The mean patient age was 6.7 ± 2.4 years, and the mean postoperative follow-up was 12.9 ± 7.2 months. Eyelid shape and function were well maintained in 904 patients (95.9%), with no recurrence during follow-up. Among the recurrent cases (39 patients [4.1%]), 19 patients (2%) underwent a second correction surgery. CONCLUSIONS: Minimal skin and orbicularis oculi muscle resection with the full thickness rotating suture technique for lower lid epiblepharon showed good surgical outcome with few complications and high success rate.

The Change of Severity of Epiblepharon after Induction of Total Intravenous Anesthesia without Muscle Relaxant

PURPOSE: To investigate the changes of epiblepharon by evaluating the severity of epiblepharon before and after induction of general anesthesia (GA) with a muscle relaxant and total intravenous anesthesia (TIVA) without a muscle relaxant. METHODS: Thirteen pediatric patients (26 eyes) underwent surgery for epiblepharon under GA using a muscle relaxant and 19 pediatric patients (38 eyes) underwent surgery for epiblepharon under TIVA without a muscle relaxant. The severity of epiblepharon in each eye was scored according to skin-fold height (scored 1-4) and area of ciliocorneal touch (scored 1-3) while the patient was in the supine position before induction and after induction of GA. RESULTS: Skin-fold height scores and ciliocorneal touch area scores decreased after induction of GA with a muscle relaxant (skin-fold height score before GA: 2.42 ± 0.86, after GA: 1.87 ± 0.88 p-value < 0.001; ciliocorneal touch area score before GA: 2.05 ± 0.70, after GA: 1.61 ± 0.68, p-value < 0.001). In the TIVA group, skin-fold height scores and ciliocorenal touch area scores were not statistically different before and after GA (skin-fold height score before GA: 2.23 ± 1.18, after GA: 2.38 ± 1.10, p-value = 0.212; ciliocorneal touch area score before GA: 2.06 ± 0.74, after GA: 1.94 ± 0.80, p-value = 0.161). CONCLUSIONS: The change of epiblepharon severity was significantly reduced by induction of TIVA without a muscle relaxant and there was no recurrence of epiblepharon 3 months after surgery. When using TIVA without a muscle relaxant, the change of epiblepharon severity was reduced and thus, this method can help prevent its undercorrection.

The Change of Severity of Epiblepharon after Induction of Total Intravenous Anesthesia without Muscle Relaxant

PURPOSE: To investigate the changes of epiblepharon by evaluating the severity of epiblepharon before and after induction of general anesthesia (GA) with a muscle relaxant and total intravenous anesthesia (TIVA) without a muscle relaxant. METHODS: Thirteen pediatric patients (26 eyes) underwent surgery for epiblepharon under GA using a muscle relaxant and 19 pediatric patients (38 eyes) underwent surgery for epiblepharon under TIVA without a muscle relaxant. The severity of epiblepharon in each eye was scored according to skin-fold height (scored 1-4) and area of ciliocorneal touch (scored 1-3) while the patient was in the supine position before induction and after induction of GA. RESULTS: Skin-fold height scores and ciliocorneal touch area scores decreased after induction of GA with a muscle relaxant (skin-fold height score before GA: 2.42 ± 0.86, after GA: 1.87 ± 0.88 p-value < 0.001; ciliocorneal touch area score before GA: 2.05 ± 0.70, after GA: 1.61 ± 0.68, p-value < 0.001). In the TIVA group, skin-fold height scores and ciliocorenal touch area scores were not statistically different before and after GA (skin-fold height score before GA: 2.23 ± 1.18, after GA: 2.38 ± 1.10, p-value = 0.212; ciliocorneal touch area score before GA: 2.06 ± 0.74, after GA: 1.94 ± 0.80, p-value = 0.161). CONCLUSIONS: The change of epiblepharon severity was significantly reduced by induction of TIVA without a muscle relaxant and there was no recurrence of epiblepharon 3 months after surgery. When using TIVA without a muscle relaxant, the change of epiblepharon severity was reduced and thus, this method can help prevent its undercorrection.

The Effects of Epiblepharon Surgery on the Improvement of Astigmatism

PURPOSE: To evaluate the changes in visual acuity and astigmatism after epiblepharon surgery regarding preoperative age and astigmatism. METHODS: We retrospectively reviewed the charts of 37 patients with epiblepharon surgery. Preoperative best-corrected visual acuity and degree of astigmatism were obtained. Postoperative data were collected at 6 and 12 months. RESULTS: The mean patient age was 5.7 +/- 2.5 years. In the 5-9 year-old group and < or =3D group, significant improvement of mean BCVA was demonstrated (p = 0.02, p = 0.039, respectively). In the cylinder groups, 1-2 D, 2-3 D, and < or =3D showed decreased mean astigmatism (p = 0.006, p = 0.034, p = 0.015, respectively). CONCLUSIONS: Significant astigmatic reduction was found after surgical correction in epiblepharon patients with higher baseline astigmatism. These results suggest that an epiblepharon surgery should be considered in patients with a high levels of astigmatism.

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

PURPOSE: To report the outcomes of acquired lower eyelid epiblepharon after various surgeries in thyroid associated ophthalmopathy (TAO) patients. METHODS: A retrospective review of the medical records of 53 TAO patients with acquired lower eyelid epiblepharon between October 1999 and June 2011 was performed. Data were collected on demographics, type of lower eyelid epiblepharon, the detailed surgical history such as orbital decompression, retraction repair, or epiblepharon repair and surgical outcomes including follow-up period, recurrence of epiblepharon, and post-operative complications. RESULTS: Among the 53 TAO patients with acquired lower eyelid epiblepharon, 25 eyes of 17 patients underwent surgical management; 6 eyes of orbital decompression, 1 eye of orbital decompression followed by retraction repair, 2 eyes of orbital decompression followed by epiblepharon repair, 6 eyes of lower eyelid retraction repair, and 10 eyes of epiblepharon repair. Twenty two lower eyelid epiblepharons (88%) were resolved after final surgical treatment without complication during mean 16.2 months (SD, +/-29.9 months) of follow up period; three of 6 epiblepharons that remained after orbital decompression underwent subsequent surgical management of retraction repair or epiblepharon repair, and epiblepharons were well-corrected. Mean amount of lower eyelid retraction was decreased from 1.68 mm (SD, +/-1.17 mm) to 0.29 mm (SD, +/-0.44 mm) after surgery, regardless of the type of surgery (n = 25, p < 0.000, Wilcoxon signed rank test). CONCLUSIONS: Acquired lower eyelid epiblepharon of TAO should be managed sequentially according to the general serial order of surgical managements in TAO; orbital decompression, correction of lower eyelid retraction and epiblepharon repair. Acquired lower eyelid epiblepharon was well resolved after surgical management in consecutive order, especially after repair of the lower eyelid retraction with a graft, or lower eyelid epiblepharon repair. Decreased lower eyelid retraction with a resolution of epiblepharon after surgery implied that lower eyelid retraction was associated with lower eyelid epiblepharon.

Visual Acuity and Astigmatism after Simultaneous Surgery for Upper and Lower Eyelid Epiblepharon in Children

PURPOSE: To study the changes in vision and astigmatism in epiblepharon patients undergoing simultaneous surgery for both upper and lower eyelid epiblepharon. METHODS: The study subjects consisted of 40 eyes of 20 patients who underwent surgery for both upper and lower eyelid epiblepharon from March 2007 to December 2008. The patients were divided into groups depending on the degree of corneal erosion. Uncorrected and best corrected vision, refractive error and the degree of corneal erosion were measured before and three months after the surgery. RESULTS: The mean patient age was 7.40 years, and all but three patients showed postoperative grade 0 corneal erosion. Mean uncorrected logMAR visual acuity was 0.44 preoperatively and 0.25 three months after the operation. The mean best corrected logMAR visual acuity was 0.13 preoperatively and 0.04 three months after the operation (p = 0.02, 0.01). Mean astigmatism showed a significant decrease from 1.46 preoperatively to 1.19 three months after surgery (p = 0.03). CONCLUSIONS: After simultaneous surgery for upper and lower eyelid epiblepharon in children, uncorrected and best corrected visual acuity and corneal erosion were all improved. The astigmatism was largely with-the-rule, both before and after surgery.

The Effect of Epiblepharon Surgery on Visual Acuity and With-the-Rule Astigmatism in Children

PURPOSE: To evaluate the effect of epiblepharon surgery on visual acuity and with-the-rule astigmatism in children compared to patients without surgical treatment. METHODS: We undertook a retrospective case control study and reviewed the charts of 202 eyes treated with epiblepharon surgery and of 142 eyes without surgery. The surgical procedure for epiblepharon correction used rotating suture techniques. Data regarding age, best corrected visual acuity, and degree of astigmatism were recorded. Baseline and 1-, 3-, 6-, and 12-month postoperative data were collected. The chi-square test, Student's t-test and general linear model analysis for repeated measures were applied. RESULTS: The mean astigmatism in the surgical group decreased from 1.10 +/- 1.02 diopter (D) preoperatively to 0.84 +/- 1.05 D at 3 months after surgery (p < 0.05). However, there was no statistically significant difference compared to the non-surgical group during the first year. The general linear model analysis comparing the mean astigmatism between the two groups over time showed a significant group-time interaction (p < 0.05). Within the surgical group, the higher baseline astigmatic subgroup and the 5- to 8-year-old group demonstrated greater cylinder reduction over time. The change in mean visual acuity was not significant in either group. CONCLUSIONS: Significant astigmatic reduction was found after surgical correction in epiblepharon patients. Patients with higher baseline astigmatism exhibited greater astigmatic reduction after epiblepharon surgery. These results suggest that, in order to reduce astigmatism, an epiblepharon operation should be considered in patients with a high level of astigmatism.

Lower Eyelid Epiblepharon Associated with Lower Eyelid Retraction

PURPOSE: To describe a series of patients with lower eyelid epiblepharon associated with lower eyelid retraction. METHODS: We 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. RESULTS: Twenty-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. CONCLUSIONS: In 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.

Correction of Upper Lid Entropion in Childhood

Entropion is usually classified into congenital entropion, secondary entropion due to epiblepharon, cicatricial, involutional and spasmodic entropion. In cases of infants and children, congenital upper lid entropion, which is caused disinsertion and dysgenesis of levator aponeurosis, and epiblepharon with excessive skin are most common. Congenital entropion requires a surgical treatment because that is hard to be cured spontaneously. And epiblepharon that cause corneal irritation persistently, also requires a surgical treatment. As we got satisfactory results of repairs of upper lid entropion in childhood, both functionally and cosmetically, we report those. We performed surgical repair of 11 children with upper lid entropion from Jan. 2003 to Aug. 2006. Five of those, who had lower lid entropion also, repaired it together with upper lid entropion. Children were 2 to 14 years old, average 8 years old, and mean follow-up assessment period was 12 months. Under the general anesthesia, we drew the line on the prearranged double eyelid placing 5~6mm from superior border of eyelash. After removing connective tissues on and near of orbicularis oculi, orbital fat was preserved as much as possible. Then we fixed posterior surface of orbital septum or levator aponeurosis to dermis or superior border of tarsal plate under prearranged double eyelid line. In this time, the location of fixation should be determined carefully not to make lagophthalmos and to make eyelash facing upward. We've got sufficient results from all of 11 children functionally as well as cosmetically, and there were no complication such as asymmetric eyelid, lagophthalmos or a relapse during the follow-up period. When it comes to entropion, which is unable to be cured naturally, surgical treatment is required before the functional problems occur. It is important to decide the timing of surgery, thus observe lashes to rub the corneal carefully. It is difficult to correct appropriately, because the operation is performed in general anesthesia. Thus, the meticulous surgical technique and surgeon's experience are important for the correction of entropion in children completely.

Ocular Hypertensive Response to Topical Dexamethasone Ointment in Children

PURPOSE: To investigate the rate and the degree of the ocular hypertensive response to dexamethasone ointment in children undergoing eyelid surgery. METHODS: Dexamethasone ointment (Dexcosil(R)) was applied three times a day for the first week and twice a day for the second to third week postoperatively to children undergoing epiblepharon surgery. Intraocular pressure (IOP) was measured on the day before surgery, postoperative day 1, 7, 14, 21, 28 and 2 weeks thereafter until the IOP reached preoperative levels. Peak IOP, IOP net increase and time to reach a peak IOP were analyzed. Dexamethasone ointment was discontinued if the IOP was 25 mmHg or more. RESULTS: A total of 96 children (mean age, 6.5+/-2.7 years) were included. Preoperative mean IOP was 13.6+/-2.9 mmHg (range 7-19). After dexamethasone ointment treatment, the children showed a significant rise in IOP as compared with the preoperative values. The peak IOP was 20.6+/-4.9 mmHg (range 11-39) and the time to reach peak IOP was 8.5+/-5.9 days. The low responders (delta IOP or =16) comprised 8.3% (8/96) of patients. A net increase in IOP was significantly higher in children 5 years old or less as compared with those older than 5 years (age5, 6.3+/-4.4 mmHg; p=0.015, unpaired t-test). CONCLUSIONS: Ocular hypertensive response after dexamethasone ointment to the eyelids occurred frequently in children, especially those 5 years old or younger.

New Incision Line for Epiblepharon Repair

PURPOSE: To evaluate the clinical efficacy of a procedure using a new incision line in cases of epiblepharon. METHODS: This study comprises 199 eyes of 105 patients (56 males, 49 females) clinically diagnosed with epiblepharon. The mean period of follow-up was 4.42 months. After marking the punctal position, the medial limit of the incision line was determined so as not to exceed the medial canthus, and the lateral limit was determined so as not to touch the cilia. The lower incision line was a folded line of skin formed after pulling the upper skin of the medial canthal area or after a downward gaze of the patient. The upper incision line was parallel to the lid margin from the medial limit and met the lower incision line at the lateral limit. RESULTS: Recurrence happened in three eyes, but only one of them underwent re-operation. The other 2 eyes showed weak touching not to need operation. There were no postoperative complications. CONCLUSIONS: This procedure with a newly designed incision line for cases of epiblepharon showed a low recurrence rate and good cosmetic results, with a reduced operation time.

Changes in Astigmatism after Surgical Repair of Epiblepharon or Ptosis: A Vectorial-analytic Approach

PURPOSE: To analyze the changes of astigmatism and keratometric cylinder by using the scalar and vector analysis method in children who had undergone surgery for epiblepharon or ptosis. METHODS: The study subjects were 142 eyes of 79 patients who had undergone surgery for epiblepharon or ptosis. We examined the cycloplegic refractive error and keratometric astigmatism by auto-refractometry before and 2 months after surgery. Astigmatic changes were analyzed through the scalar and vector analysis method. RESULTS: The mean age of the patients was 5.27+/-2.18 years of age, and the male to female ratio was 35: 44. There were 98 eyes of 49 patients in the epiblepharon surgery group, 28 eyes of 22 patients in the ptosis surgery group, and 16 eyes of 8 patients in the epiblepharon and ptosis surgery (combined surgery) group. The epiblepharon surgery group demonstrated a decrease in with-the-rule astigmatism, and the changes in magnitude (p<0.001) and vector (p<0.05) of keratometric cylinder were statistically significant. The ptosis surgery group demonstrated an increase in with-the-rule astigmatism and the changes in magnitude and vector of astigmatism were statistically significant (both p<0.01). The combined surgery group demonstrated an increase in with-the-rule astigmatism and the changes in vector of astigmatism and magnitude of keratometric cylinder were statistically significant (both p<0.05). CONCLUSIONS: Our results showed significant astigmatic change in eyes that underwent surgery for epiblepharon or ptosis. Therefore, careful cycloplegic refraction is necessary after epiblepharon or ptosis surgery.

Surgical Correction for Upper Lid Epiblepharon and Epicanthal Fold in Children

PURPOSE: We evaluated the surgical correction for upper lid epiblepharon and epicanthal fold. METHODS: Epiblepharon repair of the upper lid and epicanthoplasty were performed for patients who had a significant epicanthal fold, by which resultant cilia-cornea touch would be expected of the epiblepharon repair alone. From June, 1998 to February, 2004, 21 patients were operated on and 7 of the patients had Down's syndrome. RESULTS: The mean age of the patients at the time of the surgery was 8.6 years. In all the patients, the epicanthal folds were type 3, according to the Park's classification. Thirteen patients, including Down's syndrome patients, underwent modified Y-V advancement and eight patients underwent root Z-epicanthoplasty. The cilia-cornea touch was relieved in all of the patients except for those with Down's syndrome. Hypertrophic scar was seen in 7 patients with modified Y-V advancement and in 1 patient with root Z-epicanthoplasty until postoperative 3 months. CONCLUSIONS: Epiblepharon repair along with epicanthoplasty was effective in relieving cilia-cornea touch in children with upper lid epiblepharon and significant epicanthal fold. Root Z-epicanthoplasty can be recommended for growing children, considering that it provides moderate degree epicanthal correction and does not leave noticeable scar.

Modified Hotz's Operation to Reduce the Dog-ear Formation after Epiblepharon Repairing Surgery

PURPOSE: To discover an the operative technique to reduce the dog-ear formation which develops after epiblepharon and entropion repairing surgery. METHODS: This study reviewed the records of 38 consecutive patients who had undergone epiblepharon surgery. The results of the surgical correction, dog-ear formation and the complications were reviewed retrospectively. The new operative procedure adopted the sine curve-shaped skin incision instead of the conventional crescent-shaped skin incision. After resection of redundant skin and pretarsal orbicularis muscle, tarsal fixation of subcutaneous tissue and skin was performed. After the epiblepharon repair, we observed the formation of dog-ear by the modified Hotz procedure. RESULTS: There were 22 males and 16 females. The average age at surgery was 4.8 years and the average follow-up period was 22.4 weeks. There were no cases of cilia touch recurrence and dog-ear formation using the new operative procedure. CONCLUSIONS: This operative technique produced improved cosmetic result by preventing the formation of dog-ear which can develop after repair surgery for epiblepharon and entropion.

The Results of the Celsus-Hotz Procedure and Rotating Suture Technique in the Surgical Correction of the Epiblepharon

PURPOSE: To compare the effect of epiblepharon surgery using the Celsus-Hotz and rotating suture techniques. METHODS: This study reviewed the records of 118 consecutive patients who underwent epiblepharon surgery. The gender distribution, the age at surgery, the clinical manifestation, the results of the surgical correction and the complications were reviewed retrospectively. In group A, a resection of the skin and orbicularis oculi muscle with a tarsal plate fixation was performed (Celsus-Hotz procedure). In group B, after a subciliary incision, several buried 8-0 nylon sutures were placed to allow adhesion between the tarsal plate and the subcutaneous tissue of the upper skin flap with a minimal resection of the pretarsal orbicularis and redundant skin (rotating suture technique). RESULTS: There were 61 males (51.7%) and 57 females (48.3%). The average age at surgery was 5.3 years and the average follow-up period was 13.8 weeks. In group A, 5 of the 62 patients had a recurrence of the cilia touch and 1 patient underwent additional surgery. In group B, 2 of the 56 patients showed a reappearance of the cilia touch and 3 patients had a postoperative transient abnormal lower lid crease, which was more prominent at the down gaze. The lower lid crease of 2 of those patients disappeared during the follow-up period. CONCLUSIONS: In the surgical correction of the epiblepharon, the results of both the Celsus-Hotz procedure and rotating suture technique were functionally pleasing. The rotating suture technique is an effective method for correcting the epiblepharon, and there were no significant differences in the recurrence rate and the improvement in visual acuity between groups A and B.

Modified Continuous Buried Suture Technique for Upper Lid Epiblepharon

PURPOSE: To evaluate the effectiveness and complication rate of our modified continuous buried suture technique for the correction of the upper lid epiblepharon. METHODS: This retrospective study included 132 eyes of 66 patients, who were diagnosed with upper lid epiblepharon from March 2000 through April 2002 After the followup of over 6 months, we evaluated the improvement and recurrent rate of epiblepharon after the procedure. RESULTS: In 131 of 132 eyes with the mean followup period of 12.9 months, the epiblepharon was corrected successfully with cosmetically satisfactory Results. In 1 eye, we experienced the disappearance of a double fold without the recurrence of the epiblepharon. CONCLUSIONS: This modified continuous buried suture Method appears to be an effective treatment of lash inversion in upper lid epiblepharon with good aesthetic Results.

Surgical Correction of Cilio-corneal Touch Combined with V-Y Advancement Flap

PURPOSE: The purpose of this study is to evaluate the functional and cosmetic results of V-Y advance-ment flap procedure to correct medial cilio-corneal touch. METHODS: The 8 patients with corneal erosion induced by medial cilio-corneal touch, whose post-operative follow up periods were longer than 3 months, were reviewed retrospectively. RESULTS: All patients underwent V-Y advancement flap procedure. Five patients (10 upper eyelids) under-went slinging procedures and 2 patients (3 lower eyelids) underwent epiblepharon repair simul-taneously. One patient (1 lower eyelid) showed recurrence of cilia touch but reoperation did not undertake. CONCLUSIONS: V-Y advancement flap procedure produced satisfied results functionally and cosmetically.

The Effect of Upper and Lower Lid Blepharoplasty for Patients with Corneal Problems due to Medial Upper and Lower Eyelash

PURPOSE: Epicanthal folds and epiblepharon which often develop in oriental children are congenital anomalies of eyelids. These may need surgical correction because corneal irritation may develop by medial upper and lower eyelash besides cosmetic problems. V-Y plasty and Mustarde's method are standards for correction of epicanthal folds, but not usually performed because of cosmetic scar formation. METHODS: This study included 26 patients, 52 eyes (19 females, 38 eyes; 7 males, 14 eyes) with corneal irritation due to medial upper and lower eyelash. We performed upper and lower lid blepharoplasty simultaneously and analyzed their results and complications through medical records. RESULTS: Epiblepharon associated with epicanthus tarsalis was found in 22 patients, 22 eyes, epicanthus palpebralis in 4 patients, 8 eyes. At the time of surgery mean age was 7 years old (3.7~10.3 years old). During the follow-up more than 6 months, double fold asymmetry was found in 1 patient, double fold loosening in 1 patient, 2 eyes, lower eyelid undercorrection in 2 patients, 3 eyes. CONCLUSIONS: These findings suggest that simultaneous upper and lower lid blepharoplasty for patients with corneal problems due to medial upper and lower eyelash is more unsatisfactory in the cosmetic result than standard method, but has advantage of less scarring, and thought to be a good method to relieve corneal irritation.

Astigmatism in Children with Epiblepharon

PURPOSE: To compare the prevalance and the amount of astigmatism between the epiblepharon patients who had been operated epiblepharon and normal school children. METHODS: The noncycloplegic refraction using autorefractor was performed in 120 epiblepharon patients from Jan. 1997 to June 2000. Astigmatism in excess of 0.5 D was studied. We compared the findings of epiblephron patients and 443 normal school children in Seoul. RESULTS: The prevalence of astigmatism was 72.9% in epiblephron group and 41.6% in normal children group, and the difference was statistically significant (P< 0.001). The amount of astigmatism was 1.52 D and 0.73 D in each group, and the difference was statistically significant (P< 0.001).The distribution of astigmatism showed 1.0 D or less in 22.5%, from above 1.0 D to 2.0 D or less in 26.3%, from above 2.0 D to 3.0 D or less in 10.8%, from above 3.0 D to 4.0 D or less in 9.6% and above 4.0 D in 3.8% in epiblepharon group and in normal children group 26.2%, 11.2%, 2.6%, 1.0%, and 0.7% respectively. The difference between both groups was statistically significant (P< 0.001). With-the-rule astigmaism was found in 77.9% and against-the-rule was 22.1% in epiblephron group and 72.8% and 27.2% respectively in normal children group. CONCLUSIONS: The prevalence and the amount of astigmatism were higher in epiblepharon group than in normal children group. It might be caused by the increase of orbicularis muscle tone and the effect of skin fold overriding lid margin in epiblepharon patients.