Orbicularis muscle fixation downward for the correction of congenital epiblepharon in Chinese patients

J Plast Reconstr Aesthet Surg. 2023 Oct:85:159-164. doi: 10.1016/j.bjps.2023.06.066. Epub 2023 Jul 3.


Background: Congenital epiblepharon (CE) is a congenital eyelid deformity unique to young individuals of Asian descendants, and it might cause a sequence of other complications such as corneal damage and ocular foreign body sensation. Surgery is the most effective approach to treat this condition. Here, this study evaluated the effectiveness and safety of the orbicularis muscle fixation downward (OMFD) procedure for correcting CE.

Methods: This study enrolled 29 patients who were diagnosed with CE. These patients experienced significant ocular irritation leading to epiphora and corneal injury and, therefore, they underwent the OMFD procedure that was performed by the same surgeon. The cases were divided into 3 grades according to postoperative outcomes.

Results: The OMFD procedure was performed on 55 lower lids of the 29 patients. The average age of the patients was 9.6 years. The mean follow-up duration was 17 months. No perioperative complications were observed, and successful surgical outcomes were achieved in all 29 patients. No postoperative necrosis, infection, or corneal epithelial injury occurred. None of the patients exhibited significant scarring. Three patients showed residual 1-3 eyelashes touching the nasal corneal or bulbar conjunctiva at the inner canthus during the last postoperative examination. These patients did not undergo further surgery as there were no obvious irritation symptoms or corneal damage.

Conclusions: The fixation of the pretarsal orbicularis muscle is a simple and effective modification of the Hotz procedure to correct CE. The key aspect of this procedure is the suturing of the pretarsal orbicularis muscle and the lower eyelid retractors.

Keywords: Congenital epiblepharon; Lower eyelid retractors; Orbicularis muscle fixation downward; Pretarsal orbicularis muscle.

MeSH terms

  • Child
  • Conjunctiva
  • East Asian People
  • Eyelashes*
  • Eyelid Diseases* / congenital
  • Eyelid Diseases* / surgery
  • Eyelids* / surgery
  • Humans
  • Muscles* / surgery
  • Retrospective Studies

Supplementary concepts

  • Epiblepharon of Upper Lid