In an eye with lower lid epiblepharon, identify whether the patient has been symptomatic from trichiasis. If possible, perform a careful slit lamp examination to identify trichiasis and other signs of corneal issues. Look for punctate epithelial erosions, frank corneal epithelial defects, and/or scarring. Occasionally children will adopt abnormal head postures to keep lashes off the cornea or out of the visual axis (Fig. 36.1). Ageappropriate visual acuity assessment and refraction are also critical to understanding the clinical impact, while ensuring that appropriate refractive and amblyopic treatments are pursued.