Purpose: To examine the sex-specific differences in age distribution of Japanese patients with congenital lower eyelid epiblepharon.
Study design: A retrospective, observational study.
Methods: A total of 291 patients (87 men, 204 women) who underwent modified Hotz for correction of congenital lower eyelid epiblepharon were included in this study. Data on sex, age at surgical intervention, and affected side were collected. Patients' age was classified according to the orbital growth pattern (0-3 years, 4-6 years, 7-12 years, 13-15 years, and ≥ 16 years). The sex-specific difference in age distribution was analysed using Pearson's chi-squared test.
Results: Among male patients, 75 (86.2%) underwent surgery during 4-12 years of age. Only 2 (2.3%) boys had surgery at 13-15 years and 1 had it while he was ≥ 16 years. Among female patients, 11 (5.4%) underwent surgery at 13-15 years and 59 (28.9%) at ≥ 16 years. The age distribution was significantly different between sexes (P < 0.001).
Conclusion: Among patients aged ≥13 years, there were more women compared to men. This implies that congenital lower eyelid epiblepharon is more persistent in females and may reflect slower and less orbital growth from 13 years of age and onwards in females. The results suggest that as long as there are no severe corneal complications and no risk for amblyopia, conservative management may be a good option for males since spontaneous resolution is likely to occur. However, for females aged 13 years or more, the threshold for surgical intervention should be lower.
Keywords: age distribution; congenital lower eyelid epiblepharon; management; orbital growth; sex-specific difference.