Modified Lower Eyelid Retractor Relocation: A More Reliable Surgical Approach for Epiblepharon

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.