Evaluation of epicanthoplasty for child epiblepharon

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.