Is it truly necessary to add epicanthoplasty for correction of the epiblepharon?

Background: There are many modified variations of the original Hotz procedure for the repair of the epiblepharon. No matter which procedure is used, there must be some factors that may cause recurrence. One of possible causes of these unsatisfactory results can be due to the presence of epicanthal folds (EFs) among the oriental population. It is important to determine whether patients should be repaired with the simple epiblepharon or if it should be combined with epicanthoplasty especially for actively growing children.

Methods: All the patients were between 4 and 7 years old and had both epiblepharon and EF. The EFs were classified in 3 types, and all patients were operated on with the modified Hotz procedure. A "good" outcome was defined to be no contact between the eyelash and eyeball, and a "fair" outcome was defined to be several eyelashes contact with the eyeball, without any annoying symptoms. A "poor" outcome was defined to be most of the eyelids still in contact with the eyeball, and these patients persistently complain of irritation or keratitis.

Results: The study included 46 lower eyelids of 23 patients (14 females, 9 males; mean age, 5.7 years) who underwent operation. Thirty-five eyelids (76.1%) were assessed to have a "good" outcome, 9 eyelids (19.6%) were assessed to have a "fair" outcome, and 2 eyelids (4.3%) were assessed to have a "poor" outcome.

Conclusions: We firmly believe that epicanthoplasty is not necessarily performed routinely for all epiblepharon unless there is any specific reason to justify the combined procedure.