Morphological changes in the eyelid following modified rotational suturing combined with lower eyelid margin fixation for the correction of congenital lower eyelid epiblepharon

To quantitatively evaluate morphological changes of the eyelid in congenital lower eyelid epiblepharon before and after surgery using modified rotational suturing combined with lower eyelid margin fixation. This aims to provide clinicians with objective criteria for surgical outcome evaluation. A prospective self-controlled study was conducted. Standardized anterior and lateral photographs were collected from 83 patients (166 eyes) who underwent surgical correction for congenital lower eyelid epiblepharon between May 2022 and October 2024. All patients received modified rotational suturing combined with lower eyelid margin fixation. Photographs were taken preoperatively, and at postoperative 1 month (PO1M), 3 months (PO3M), and 6 months (PO6M). Anterior photographs measured: marginal reflex distance 1 (MRD1), marginal reflex distance 2 (MRD2), interepicanthal fold distance (IEFD), eyelid fissure area (EFA), nasal scleral area (NSA), Modified Vancouver Scar Scale (Vancouver Scar Scale, VSS). Lateral photographs measured the average angle between the eyelash tips and the corneal apex tangent (Side-View Angle, SVA). Using ImageJ software with the horizontal corneal diameter (11 mm) as a reference scale, photographic measurements were recorded. Preoperative and postoperative changes were statistically analyzed using the Friedman nonparametric test in SPSS 27.0. MRD1, EFA and NSA significantly increased from preoperative levels to its maximum value at PO1M, with a slight regression observed at PO3M. MRD1, EFA and NSA significantly increased at PO6M compared to preoperative levels ( P = 0.000, P = 0.039, P = 0.039). SVA significantly increased postoperatively ( P = 0.000). The highest value was at PO1M, At PO6M, the SVA was significantly larger than the preoperative value ( P = 0.000). Postoperative scar scores were overall low. The highest median score occurred at PO1M, decreasing progressively at PO3M and PO6M ( P = 0.000). Over 6 months postoperatively, modified rotational suturing with lower eyelid margin fixation yielded good aesthetic results and no recurrence in congenital epiblepharon correction in Asian children. These findings describe the 6 months outcomes of this technique. They may help surgeons and guardians understand the expected postoperative morphological changes.