Variations in the degree of epiblepharon with changes in position and induction of general anesthesia

Background: To investigate the changes of epiblepharon by evaluating the severity of epiblepharon before and after induction of general anesthesia. Methods: Sixty-three pediatric patients (126 eyes) underwent surgery for epiblepharon between April 2008 and September 2008 (35 females, 28 males; average age: 4.74 years). The severity of epiblepharon in each eye was scored according to skin-fold height (scored 1-4) and area of ciliocorneal touch (scored 1-3) while the patient was in upright and supine positions before induction of general anesthesia and in supine position after induction of anesthesia. Results: The severity of epiblepharon was significantly reduced by a positional change to supine position and induction of general anesthesia. Skin-fold height scores decreased when patients were moved from upright (estimated mean ± standard error [SE]; 2.98 ± 0.08) to supine position (2.63 ± 0.09) (P < 0.001) prior to induction of anesthesia, and decreased further after induction of general anesthesia (2.12 ± 0.08) (P < 0.001). Ciliocorneal touch scores also decreased after patients were moved to supine position and after induction of general anesthesia (upright: 2.17 ± 0.05; supine: 1.95 ± 0.06; general anesthesia: 1.64 ± 0.07, P < 0.001). Conclusions: Our study demonstrates that positional changes and general anesthesia using muscle relaxants affect the degree of epiblepharon. Surgeons should be aware of these variations for operative planning of epiblepharon.