Epiblepharon is typically congenital or developmental and is characterized by a redundant anterior lamella resulting in a horizontal skin fold that overrides the lower lid margin. The overriding skin and muscle results in the lashes being misdirected toward the cornea and bulbar conjunctiva (Figure 13.1A and B). Diagnosis is based on clinical examination. Gentle downward traction on the skin of the lower eyelid reveals the lid margin to be in normal position, which distinguishes this entity from lower lid entropion. Epiblepharon is often self-limited in that it improves or resolves with time. Around the age of 1, when infants begin to walk, their faces thin and the loss of the anterior cheek mass leads to less overriding of skin at the lid margin. Similarly, around the age of 5, the midface lengthens with the developmental growth of the nasomaxillary complex of the facial skeleton. This results in a decrease in the mechanical forces that lead to overriding of the skin and muscle at the lower lid margin and may allow for spontaneous correction of epiblepharon.

In an eye with lower lid epiblepharon, identify whether the patient is symptomatic from the misdirected lashes. If possible, perform a careful slit-lamp examination to look for misdirected lashes and signs of corneal pathology. Look for punctate epithelial erosions, frank corneal epithelial defects, and scarring. Occasionally, children will adopt an abnormal head position to reduce the central cornea-lash touch. Age-appropriate visual acuity assessment and refraction are also critical to understanding the clinical impact, while ensuring that appropriate refractive and amblyopic treatments are pursued.