Most lower lid entropion in children causes an inverted eyelash, where the eyelashes that should be growing forward grow upward and rub against the surface of the eye. In young children, the eyelashes are short and soft, and there is usually no damage to the cornea. As the child grows up and the eyelashes grow long and hard, the lower eyelid position does not develop properly and the impingement remains. The eyelashes usually abrade the cornea, creating a trauma on the cornea that can easily become infected secondary to the eyelashes. Mild corneal abrasions can be treated conservatively by observing the changes in the impingement and waiting for it to slowly grow back. Severe cases may require surgical treatment to correct the entropion and remove the adverse effects of the eyelashes on the cornea. The usual surgical procedure is the buried suture method. This involves making a full suture from the conjunctiva of the fornix to the skin of the eyelid at the lower eyelid margin, with anywhere from one to three stitches depending on the specific condition of the child. The suture ligation will ligate the deep and superficial tissues of the lower eyelid together and after a period of time, usually 10 days, the sutures will be removed and adhesions will form between the tissues. As a result, the skin near the root of the eyelashes will no longer turn inward due to the pulling of the deeper tissues, and the direction of eyelash growth will change from upward to forward growth, removing the effect of the impingement on the cornea. This method is simple to perform and causes little local tissue damage, and is generally the treatment of choice for children with lower lid entropion. However, some children are prone to recurrence, such as obese children, and may require other surgical procedures, such as deep fixation. The reasoning behind deep fixation is the same as that of buried sutures, in that there is a force that pulls the lower lid skin deeper and changes the direction of the eyelash growth. To perform the procedure, the skin of the lower lid near the lid margin is cut horizontally parallel to the lid margin, and if the orbicularis muscle is hypertrophic some of the orbicularis muscle is removed, the lower lid plate is found, and intermittently, the lower lid skin incision is sutured and fixed to the lower lid plate at the same time. In this way, the lower eyelid skin is better because it is fixed to the deeper tissue and the entropion is improved. This procedure will be slightly more complex than the buried suture method, but the surgical results are more tangible. These are the 2 common surgical methods used to correct lower lid entropion in children. The exact type of treatment that should be used for each child will depend on the child’s specific condition and will be determined by the surgeon. As you can imagine, either method will leave some surgical marks on the skin of the child’s lower eyelid. However, they are usually not noticeable and the surgeon will try to take into account aesthetic concerns during the surgery. The purpose of this procedure is not to make the child more aesthetically pleasing, but to correct the impingement of the eyelid and to remove the negative effects of the impingement on the surface of the eye, mainly the cornea.