This study aimed to compare the surgical outcomes of pediatric patients with intermittent exotropia who underwent simultaneous eyelid and exotropia surgery and those who underwent exotropia surgery alone. The medical records of patients aged <18 years who underwent surgery for intermittent exotropia were retrospectively reviewed. The patients were grouped according to whether they underwent simultaneous eyelid surgery. In the simultaneous surgery group, the association between clinical factors, including the type of eyelid procedure, and surgical success was also analyzed. A favorable outcome was defined as an ocular alignment of ≤10 prism diopters (PD) for exodeviation and ≤4 PD for esodeviation at the final follow-up. This study included 118 patients, of whom 31 underwent simultaneous eyelid and exotropia surgery and 87 underwent exotropia surgery alone. Bilateral repair of lower eyelid epiblepharon was the most common eyelid procedure (27/31, 87.1%). Success rates did not differ significantly between the two groups (log-rank test, p=0.291). In the simultaneous surgery group, no clinical factors, including the type of eyelid surgery, were significantly associated with favorable outcomes (all p>0.05). Simultaneous eyelid and exotropia surgery produced surgical outcomes comparable to those of exotropia surgery alone, validating the safety and feasibility of the combined procedure in appropriately selected pediatric patients.

Lower eyelid epiblepharon is a condition that is common in Asian children and improves with age in most patients; however, the problem can persist until school age or even adulthood. No difference has been observed in terms of incidence in association with sex or the affected eye, and the condition mainly affects the lower eyelid, usually in both eyes. The condition typically features horizontal semilunar skin folds lying parallel to the palpebral margin that accumulate and push the eyelashes towards the ocular surface, which rub against the cornea, resulting in corneal injury and irritation symptoms that affect the daily life of the child. Surgery remains the currently preferred method for alleviating corneal irritation symptoms. Although diverse surgical procedures are available in terms of clinical practice, the modified Hotz procedure remains the most widely used. The surgical procedure primarily focuses on two key aspects: the precise determination of the amount of skin to be removed and improving the tightness between the palpebral retractor aponeurosis and the anterior layer of the eyelid. In this study, lower eyelid epiblepharon is categorized into three distinct types based on the affected area: medial lower eyelid epiblepharon (affecting the medial skin of the lower eyelid); central epiblepharon (involving half of the lower eyelid); and total involvement Type A epiblepharon (involving the full-length of the eyelid). The surgical approach was tailored according to classification, with Type A cases receiving L-shaped excisions and Types B and C crescent-shaped incisions. The postoperative outcomes were evaluated to determine the cure rate. Most patients experienced mild postoperative reactions, and no obvious sunken scars or double lower eyelids were observed. Satisfactory results were thus obtained with mild postoperative reactions.

The surgical management of corneal lesions resulting from eyelid pathologies requires a comprehensive approach to ensure optimal patient outcomes. Eyelid lesions, ranging from benign to malignant, can lead to corneal damage through mechanisms such as mechanical abrasion, secondary infection, or inflammatory responses. To assess the surgical methodologies utilized in the treatment of corneal lesions resulting from eyelid disorders and evaluate their effects on patient outcomes, recurrence rates, and postoperative complications. The incorporation of advanced imaging techniques, including optical coherence tomography and ultrasound biomicroscopy, in conjunction with histopathological analysis, is addressed to improve surgical accuracy and patient outcomes. The authors searched online databases (PubMed and Cochrane) for publications on the surgical management of lid lesions. Records received from the two databases were checked for duplicates and relevance. Only records with full texts and in English language were included. A total of 28 records were obtained following the screening for relevancy and duplication. The review underscores essential surgical approaches employed in the treatment of corneal lesions resulting from common eyelid diseases, focusing on operative efficacy, complication rates, and long-term results. This systematic review emphasizes the significance of choosing suitable surgical techniques tailored to individual patient characteristics and stresses the need for interdisciplinary collaboration in ophthalmic care. The results indicate that sophisticated imaging techniques and careful preoperative preparation markedly improve surgical accuracy and long-term results.

Epiblepharon is a common disease in Asian children. It may cause astigmatism and amblyopia; hence, some cases require surgical treatment. Although the modified Hotz procedure is a common surgery, some cases of recurrence have been reported. One of the causes is the presence of the epicanthal fold. In this study, we retrospectively investigated the applicability of epicanthoplasty for epiblepharon in children based on the severity of the epicanthal fold. Patients under 13 years of age were evaluated to determine whether the modified Hotz procedure should be combined with epicanthoplasty based on the severity of epicanthal fold and rates of recurrence. The severity of the epicanthal fold was classified into 3 levels (mild, moderate, and severe) according to Wang's classification based on the degree of epicanthal fold covering the lacrimal caruncle. A total of 58 eyes were investigated with a mean age of 7.6 (4-13) years. The mean observation period was 11 (6-30) months. Thirty patients underwent the modified Hotz procedure alone and it was combined with epicanthoplasty in 28 patients. Although there were no differences in the recurrence rate between the mild and moderate cases, the recurrence rate in the group that underwent the modified Hotz procedure combined with epicanthoplasty was significantly lower than the group that underwent the modified Hotz procedure alone for the severe cases (0% vs. 33.3%). Therefore, it is suggested that the classification of epicanthal fold severity is useful for determining the surgical procedure, and that epicanthoplasty is necessary only in severe pediatric cases.

Epiblepharon is a congenital anatopism characterized by a horizontal skinfold near the eyelid margin, causing corneal irritation and damage. Standard surgical management occasionally results in undercorrection and relatively high recurrence. In addition, a pronounced postoperative lower eyelid crease can be an unfavorable cosmetic alteration, particularly for Asian patients. This work describes a new surgical technique to reduce recurrence rates while improving cosmetic and functional outcomes for epiblepharon. Thirty-nine patients (75 eyelids) underwent epiblepharon surgery from January 2021 to April 2023. Their mean age was 15.0 years with a mean follow-up period of 16.5 months. Surgically, the lower eyelid retractors (LERs) were fully exposed and detached from the inferior tarsus margin and conjunctiva. The free LERs were sutured directly to the marginal orbicularis oculi muscle, maintaining flexible mobility to the LERs without standard anchoring to the tarsus margin. All 39 patients achieved complete eversion of the cilia without cornea contact by the final follow-up. Of the 75 eyelids, 70 (93%) demonstrated a "good" outcome, 5 (7%) had a "fair" outcome, and none were classified as "poor." Mean margin-to-reflex distance 2 remained statistically unchanged between preoperative and postoperative measurements. Our new surgical method provides satisfactory functional and cosmetic results, reducing recurrence rates and minimizing the risk of excessive lower eyelid crease, ectropion, and severe hypertrophic scarring. The method offers a reliable alternative, particularly for Asian patients, who typically have less pronounced eyelid creases.