Cause analysis and reoperation effect of failure and recurrence after epiblepharon correction in children

BACKGROUND: In children, it is common to see failure and recurrence in the correction of epiblepharon and to have reoperation due to obvious irritation symptoms and corneal injury. AIM: To explore the causes of failure and recurrence after epiblepharon correction in children, to remove accurately redundant epiblepharon and orbicularis oculi muscle in patients via the cilia-everting suture technique combined with lid margin splitting in some patients due to inverted lashes in the medial part of the eyelid, and to observe the therapeutic effect. METHODS: From 2015 to 2019, in the Outpatient Department of Ophthalmology of Beijing Tongren Hospital, 22 children (40 eyes) with epiblepharon, aged 5-12 years, were treated due to correction failure and recurrence. Fourteen patients (28 eyes) underwent the full-thickness everting suture technique, and eight patients (16 eyes) underwent incisional surgery. They were treated by reviewing the previous surgical methods and observing epiblepharon, eyelash direction, and corneal injury. During reoperation, a subciliary incision was made 1 mm below the inferior lash line. Incisional surgery for the lower eyelid was used to remove accurately redundant epiblepharon and part of the pretarsal orbicularis muscle. Subcutaneous tissue and the orbicularis muscle of the upper skin-muscle flap were anchored to the anterior fascia of the tarsal plate by rotational sutures. Lid margin splitting was used only for patients who had seriously inverted lashes located in the medial part of the eyelid. All patients were followed for 6-12 mo after reoperation to observe the lower eyelid position, skin incision, eyelash direction, corneal damage, and recurrence. RESULTS: After reoperation, all the patients were corrected. Photophobia, rubbing the eye, winking, and tearing disappeared. There was no lower eyelid entropion, ectropion, or retraction. There was no obvious sunken scar or lower eyelid crease. The eyelashes were far away from the cornea, and when the patients looked down, the eyelashes on the lower eyelid did not contact the cornea or conjunctiva. The corneal injuries were repaired. Follow-up observation for 6 mo showed no recurrence of epiblepharon. CONCLUSION: The type of suture method, the failure to remove accurately redundant skin and orbicularis muscle, the lack of cilia rotational suture use, and excessive reverse growth of eyelashes are the main causes of failure and recurrence after epiblepharon correction in children.