The Correlation Between Epiblepharon and Obesity in Pediatric Patients: A Retrospective Comparative Study

Background/Objectives: Epiblepharon is a common congenital eyelid anomaly in East Asian children, often associated with redundant skin and orbicularis oculi muscle overriding the eyelid margin. Recent studies have suggested that systemic factors such as body mass index (BMI) may contribute to its development. This study aimed to investigate the relationship between BMI and epiblepharon and to analyze the correlation between BMI and skin-fold height as a marker of eyelid structural redundancy. Methods: This retrospective comparative study included 100 pediatric patients (54 males, 46 females) aged 3-13 years who underwent surgical correction for lower eyelid epiblepharon and 100 age-matched controls without the condition. Preoperative height, weight, and skin-fold height were analyzed. Intergroup comparisons were performed using independent t-tests, and correlations between BMI and skin-fold height were evaluated using Spearman correlation. Results: There were no significant differences in overall BMI, obesity index, or prevalence of obesity defined as BMI ≥ 95th percentile between groups. Boys aged 7-8 years demonstrated significantly higher BMI in the epiblepharon group, and boys aged 9-10 years showed a significantly higher obesity index in the epiblepharon group, whereas boys aged 3-4 years showed significantly lower BMI. No significant differences were observed in girls. BMI was not independently associated with epiblepharon in multivariate logistic regression analysis (OR 1.06, 95% CI 0.96-1.16, p = 0.278). Among patients with epiblepharon, BMI showed a significant negative correlation with skin-fold height (r = -0.410, p < 0.001), suggesting increased orbicularis muscle redundancy in obese children. Conclusions: BMI was not independently associated with the presence of epiblepharon; however, age-specific differences were observed in certain male subgroups. Higher BMI was correlated with lower skin-fold height among affected patients, suggesting that adiposity may influence eyelid morphology in specific developmental stages. Further longitudinal studies are warranted to clarify the age-dependent relationship between obesity and epiblepharon.