Association between head tilt and asymmetric epiblepharon

Abstract

Importance Epiblepharon is known to be bilateral and symmetric. However, asymmetric epiblepharon is frequently observed in patients with head tilt and, to date, this condition has not been investigated. OBJECTIVES To evaluate the clinical features of epiblepharon in patients with head tilt and to analyze the association between the direction of head tilt and epiblepharon asymmetry. DESIGN, SETTING, AND PARTICIPANTS The medical records of 1074 Korean children who received a diagnosis of epiblepharon between January 1, 2006, and October 31, 2013, at Seoul National University Bundang Hospital were retrospectively reviewed. The data collected included sex, age, extent and asymmetric presentation of epiblepharon, and direction and cause of head tilt. MAIN OUTCOMES AND MEASURES The presence of epiblepharon asymmetry in patients with head tilt as well as the association between the direction of head tilt and the side having more severe epiblepharon. RESULTS Of 1074 patients (536 boys; mean [SD] age, 5.4 [2.6] years) with epiblepharon, 38 individuals (3.5%) showed head tilt. The causes of head tilt were superior oblique palsy (18 patients [47.4%]), congenital muscular torticollis (10 [26.3%]), dissociated vertical deviation (3 [7.9%]), and unknown (7 [18.4%]). Asymmetric epiblepharon was more common in children with vs without head tilt (34 [89.5%] vs 80 [7.7%]; P