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Non-incisional eyelid everting suture technique for treating lower lid epiblepharon
  1. Ji Won Seo1,
  2. Sunah Kang2,
  3. Chanjoo Ahn2,
  4. Bita Esmaeli3,
  5. Ho-Seok Sa2,3
  1. 1 Department of Ophthalmology, Inje University Ilsan Paik Hospital, Goyang, Korea
  2. 2 Department of Ophthalmology, Asan Medical Center, University of Ulsan, College of Medicine, Seoul, Korea
  3. 3 Orbital Oncology and Ophthalmic Plastic Surgery, Department of Plastic Surgery, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
  1. Correspondence to Dr Ho-Seok Sa, Department of Ophthalmology, Asan Medical Center, University of Ulsan, College of Medicine, Seoul, 05505, Korea; lineblue{at}


Background This study investigated surgical outcomes of full-thickness eyelid everting sutures for lower lid epiblepharon and influential factors leading to surgical failure.

Methods A retrospective review was conducted of patients with lower lid epiblepharon who underwent surgical correction using the full-thickness eyelid everting suture technique. Lower lid epiblepharon was assessed preoperatively using a morphological classification (class I–IV) according to the horizontal skin fold height and a functional classification (grade 0–3) according to the severity of keratopathy. Four stitches with 5-0 coated polyglactin 910 sutures per eyelid were made, and all procedures were conducted under local anaesthesia in an office-based setting. To assess surgical outcomes, we evaluated undercorrection at 1 month and surgical failure at 6 months after the procedure. Several factors affecting surgical failure were also investigated

Results Sixty-eight eyes of 41 patients were included. There were no eyes showing an undercorrection at 1 month. Keratopathy was significantly improved at 6 months postoperation (P<0.01). All patients showed good cosmesis without undesired creation of a lower lid crease and no significant complications. Sixty-one eyes (89.7%) showed surgical success. Three patients (7.3%) required additional incisional surgery due to recurring irritation. The rate of surgical failure was significantly different between the patient groups classified by preoperative severity of keratopathy (P=0.026) and lower lid horizontal skin fold height (P<0.001). Multiple logistic regression analysis revealed that the lower lid horizontal skin fold height was significantly correlated with surgical failure (OR 18.367, P=0.002).

Conclusion Non-incisional eyelid everting sutures have utility for the correction of lower lid epiblepharon with advantages including its simplicity, being performed in office under local anaesthesia and minimal changes in appearance. We suggest mild to moderate epiblepharon with class I or II horizontal skin fold height and grade 1 or 2 keratopathy as the criteria for considering this suture procedure.

  • epiblepharon, surgical treatment, Quickert suture

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  • Contributors Conception and design: HSS. Analysis and interpretation of data: all authors. Drafting the article or revising it critically for important intellectual content: JWS, BE, HSS. Final approval of the version to be published: HSS.

  • Funding This research received no specific grant from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Patient consent Parental/guardian consent obtained.

  • Ethics approval The Institutional Review Board of Asan Medical Center.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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