title: Association Between Head Tilt and Asymmetric Epiblepharon.
abstract: OBJECTIVE
  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.
  
  
  OBJECTIVE
  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.
  
  
  METHODS
  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.
  
  
  METHODS
  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 < .001, Fisher exact test). Of the 34 patients with head tilt and asymmetric epiblepharon, the direction of head tilt was consistent with the side having more severe epiblepharon in 29 individuals (85.3%) and inconsistent in 5 individuals (14.7%) (P = .009).
  
  
  CONCLUSIONS
  These data suggest that, in patients with epiblepharon and head tilt, epiblepharon is most often asymmetric and is severe in the head-tilted side. These results suggest that patients with asymmetric epiblepharon should be evaluated for head tilt.
authors.affiliation: Department of Ophthalmology, Seoul National University Hospital, Seoul, Korea.
authors.forename: Bo Ram
authors.initials: BR
authors.lastname: Seol
authors.affiliation: Department of Ophthalmology, Seoul Metropolitan Government Seoul National University Boramae Medical Center, Seoul, Korea.
authors.forename: Ho-Kyung
authors.initials: HK
authors.lastname: Choung
authors.affiliation: Department of Ophthalmology, Seoul National University Bundang Hospital, Seongnam, Korea.
authors.forename: Namju
authors.initials: N
authors.lastname: Kim
authors.affiliation: Department of Ophthalmology, Hallym University Sacred Heart Hospital, Anyang, Korea.
authors.forename: Min Joung
authors.initials: MJ
authors.lastname: Lee
authors.affiliation: Department of Ophthalmology, Seoul National University Hospital, Seoul, Korea.
authors.forename: Sang In
authors.initials: SI
authors.lastname: Khwarg
mesh_terms: D002675:Child, Preschool; D003941:Diagnostic Techniques, Ophthalmological; D005133:Eye Movements / Q000502:physiology*; D005141:Eyelid Diseases / Q000151:congenital* / Q000503:physiopathology; D005143:Eyelids / Q000002:abnormalities*; D005260:Female; D019416:Head Movements / Q000502:physiology*; D006801:Humans; D008297:Male; D009801:Oculomotor Muscles / Q000503:physiopathology*; D011187:Posture; D012027:Reflex, Vestibulo-Ocular / Q000502:physiology*; D012189:Retrospective Studies