What are the other Names for this Condition? (Also known as/Synonyms)

• Acquired Epiblepharon
• Congenital Epiblepharon

What is Epiblepharon (Definition/Background Information)

• Epiblepharon is a congenital (from birth) condition that results in either the lower or upper eyelid assuming an inverted position. This inverted position folds the eyelashes onto the eye causing eye redness and irritation for the child
• Individuals with Epiblepharon will additionally experience increased tearing, foreign body sensation in the eye, constant blinking, and in severe cases, abrasions (visible scars) to the eye. However, a majority of children are asymptomatic, particularly during the younger years
• In many cases, Epiblepharon may resolve on its own within the first couple of years of life. Although, surgical correction may be necessary if the condition persists. Epiblepharon surgery has a high success and satisfaction rate

Who gets Epiblepharon? (Age and Sex Distribution)

• Epiblepharon is a congenital (appearing from birth) condition affecting young children
• Studies have shown that girls above the age of 13 are at a higher risk of Epiblepharon persistence than boys. Also, it is reported that the condition resolved itself in boys in a higher rate than girls aged 13 and above
• Most cases of Epiblepharon are noted in Hispanics and Asians. Nevertheless, individuals of all ethnic and racial groups may be affected worldwide

What are the Risk Factors for Epiblepharon? (Predisposing Factors)

Common risk factors associated with Epiblepharon include: 

• Those with parents who present with absent or weak eyelid creases. East Asian kids are at a higher risk due to higher prevalence of the condition among them
• Specifically in East Asians, tighter eyelids along with a high body mass index (BMI) is a risk factor for more severe symptoms
• Epiblepharon is generally hereditary and a family history of the condition places one at a higher risk for the same

It is important to note that having a risk factor does not mean that one will get the condition. A risk factor increases one’s chances of getting a condition compared to an individual without the risk factors. Some risk factors are more important than others.

Also, not having a risk factor does not mean that an individual will not get the condition. It is always important to discuss the effect of risk factors with your healthcare provider.

What are the Causes of Epiblepharon? (Etiology)

• Epiblepharon is the result of poor development of eyelid retractors (muscles that open the eyelids)
• A secondary cause may be enlargement of the orbicularis oculi muscle (a specific type of muscle in the eyelid). This is known as acquired Epiblepharon

What are the Signs and Symptoms of Epiblepharon?

 The signs and symptoms of Epiblepharon are generally mild and may include:

• Frequent blinking
• Eye redness and irritation; itching of the eye
• Increased tearing and discharge from the eyes
• Foreign body sensation in the eye 
• Frequent rubbing of one’s eyes
• The condition is bilateral i.e., both upper and lower eyelids may be involved. However, a large number of cases involve the lower eyelid
• Prominent lower eyelid skin fold may be seen
• The symptoms are more prominent when the child is looking down (such as while studying)
• Corneal epithelial defect (loss of function of outermost layer of cornea)
• Folding of the eyelids causes the eyelashes to appear vertical

Epiblepharon is generally asymptomatic in children during their younger years.

How is Epiblepharon Diagnosed?

Epiblepharon may be diagnosed in the following manner: 

• It is typically diagnosed on an eye examination, based on the presenting clinical features
  • Lower Epiblepharon may be diagnosed by an adduction in the lower eyelid
  • Upper Epiblepharon is more obvious to diagnose (visual exam)
• Dynamic slit lamp exam with or without corneal straining may also be used to aid in the diagnosis

Many clinical conditions may have similar signs and symptoms. Your healthcare provider may perform additional tests to rule out other clinical conditions to arrive at a definitive diagnosis.

What are the possible Complications of Epiblepharon?

The complications due to Epiblepharon are rare but may include: 

• Under-correction (post-surgery) in the medial eye
• Over-correction resulting in scarring of the eyelid or transient ectropion (lower eyelid droops and turns outwards)

How is Epiblepharon Treated?

• In the first few years of life, in many cases, Epiblepharon is known to resolve spontaneously. Hence, the healthcare provider may advise a “wait and watch” approach
• In case of non-resolution, a surgery may be planned to remove the orbicularis (eyelid muscle) and a small strip of skin from the eye

How can Epiblepharon be Prevented?

Currently, there are no specific methods or guidelines to prevent Epiblepharon since it is a genetic condition. 

• Genetic testing of the expecting parents (and related family members) and prenatal diagnosis (molecular testing of the fetus during pregnancy) may help in understanding the risks better during pregnancy
• If there is a family history of the condition, then genetic counseling will help assess risks, before planning for a child
• Active research is currently being performed to explore the possibilities for treatment and prevention of congenital disorders such as Epiblepharon

What is the prognosis of Epiblepharon? (Outcomes/Resolutions)

• The prognosis of Epiblepharon is generally good, as there is a possibility of the condition correcting itself within the first few years of the child’s life due to growth of the facial bones and eyelids (as the child grows and develops)
• The prognosis of Epiblepharon without treatment may lead to eye abrasions/scars from the inverted eyelid, necessitating a surgical rectification. Nevertheless, complications are rare with 95% satisfaction rates being reported following treatment

Additional and Relevant Useful Information for Epiblepharon:

The following DoveMed link is a useful resource for other eye and vision related articles:

https://www.dovemed.com/health-topics/vision-center/