Surgical Correction of Epiblepharon Using Thermal Cauterization of the Orbital Septum and Lash-Rotating Sutures

Abstract

Epiblepharon is a congenital eyelid anomaly frequently encountered in Asian infants and children. The purpose of this study was to describe the surgical technique of epiblepharon correction by applying both lash-rotating sutures in the inferior tarsus and the subcutaneous tissue of the upper skin flap and thermal cauterization in the septum. A retrospective, interventional study was performed on 75 patients who underwent surgical correction of epiblepharon between August 2006 and July 2007 by 1 surgeon. The upper skin incisional line was just below the eyelash line, and the delineated ellipse extended from just lateral to the punctum to the site of lash inversion. Dissection was carried out between the tarsal plate and orbital septum and the skin-pretarsal and preseptal orbicularis oculi muscle flap, thus exposing the tarsal plate and orbital septum. Thermal cauterization was applied to the orbital septum to create a cicatricial barrier adhesion between the preseptal orbicularis oculi muscle and the septum to minimize vertical overriding of the orbicularis oculi muscle. Three to 4 interrupted sutures were placed in the inferior tarsus and the subcutaneous tissue of the upper skin flap to rotate the direction of the lashes. The small amount of pretarsal orbicularis oculi muscle and redundant skin overlying the lower lid margin were removed. A total of 150 eyes (75 patients) were followed for 24.1 weeks (range, 4-12 months). Patients ranged in age from 2 to 13 years (median age, 7.3 years). All patients were diagnosed with bilateral epiblepharon, and surgery was performed on both eyelids. After a mean follow-up period of 14.1 weeks, no patients had recurrence, and all patients had good cosmetic results. Symptoms disappeared in all patients. There were no cases of lid retraction, wound dehiscence, or ectropion. Thermal cauterization of the orbital septum and lash-rotating sutures were very useful and effective for treating epiblepharon.