Why your child's bottom lashes keep brushing her eye
Her bottom lashes seem to point the wrong way, in toward the eye rather than out. Here is why that happens, why it is rarely urgent, and what actually settles it.
- The lashes usually have not changed direction. A small extra fold of skin and muscle in the lower lid is tipping them inward, while the lid margin itself is exactly where it should be.
- This is often present from birth and frequently improves as a child's face grows.
- While the lashes are still soft, this often causes no symptoms at all, and gets worse when a child looks down, for example over a book.
- Lubricant drops or ointment come first. Surgery is only considered if it has not settled or the lashes are scratching the eye.
- Plucking or cutting the lashes at home is not a treatment and is not something I recommend.
A mother lifts her toddler onto my lap and says the same thing almost every week: her bottom lashes seem to be growing the wrong way, into the eye instead of out. She has usually spent a night or two looking closely at a sleeping face with a torch, convinced she is watching something go wrong in real time. Most of the time she is not. The lashes have not changed direction at all. Something underneath them has.
Why are my child's bottom lashes touching her eye?
Because a small fold of skin and muscle in the lower lid is pushing against the lash line and tipping the lashes inward, while the lid margin itself sits exactly where it should. Doctors call this epiblepharon. It usually affects the lower lid more than the upper, sometimes both eyes, and it is frequently there from birth.
The distinction matters more than it sounds. The eyelid is not rolled in. The lash line is not misplaced. There is simply extra tissue riding up over the edge, carrying the lashes with it. That is why the lashes can look alarmingly inward turned in a photo, and yet the eye underneath is often completely undamaged.
I check this the same way each time: I look at where the lid margin itself sits, then at the direction the lashes are pointing, and then, gently, at whether the lashes are actually reaching the surface of the eye or only resting near it. Those three answers, taken together, tell me far more than the first glance at a worried photo on a parent's phone ever does.
Does this actually cause my child any discomfort?
Often, no. While a child's lashes are still soft and fine, they can rest against the surface of the eye for months without producing redness, watering or any complaint at all. Some children have no symptoms whatsoever and are only noticed because a parent looked closely.
When symptoms do show up, they tend to be a watery or slightly red eye, some irritation, or sensitivity to bright light. A watery eye in a young child has more than one cause, and it is worth telling this apart from a blocked tear duct, which is far more common and looks similar at a glance. I check both when a parent brings me a watery eye, because treating one while missing the other helps nobody.
What changes matters more than a snapshot in a single photo does. Lashes that have been resting harmlessly against a soft eye for a year are a very different picture from an eye that has newly turned red, or a child who has newly started rubbing hard at one side. The condition itself often stays quiet for a long stretch, so a genuine change is usually the more useful signal, not the presence of the fold on its own.
Why does he blink so much when he looks down at a book?
Because looking down rolls the lower lid, and the lashes riding on it, further against the eye. A child reading, colouring or looking at a tablet on a low table is in exactly the position that brings the lashes closest to the surface. Parents notice the blinking before they notice anything else, often in the car seat or at the dinner table, and it is a genuinely useful clue rather than a separate problem to worry about.
Some children respond by rubbing, and a child who rubs one eye more than the other is always worth a proper look, whatever the cause turns out to be. I go through the wider list of reasons a child rubs their eyes, and which ones need attention, in why children rub their eyes.
Screen use in a low position on a lap does the same thing as a book on a table. It is not the screen itself doing anything here, only the angle of the head. A child slumped over a tablet held near their knees is looking down for long stretches at exactly the angle that brings soft lashes closest to the eye, which is a small, practical thing worth adjusting regardless of what the underlying cause turns out to be.
Will she need an operation for inturned lashes?
Most children do not. This condition frequently improves on its own as a child's face grows and the fold of skin flattens out. While we wait, lubricant drops or a lubricant ointment protect the eye surface and settle the irritation, and that is the usual first step, not a stopgap before something bigger.
Surgery is kept for two situations: when the fold has not settled with time, or when the lashes are genuinely scratching the surface of the eye. The operation removes a small piece of skin and muscle from the lower lid so the lashes point away from the eye again. It is a considered step, not a default one, and I would rather review a child every few months than operate on a lid that is likely to sort itself out.
Left untreated in the small number of children where the scratching is genuine and persistent, the surface of the eye can become infected or scarred. That is the outcome the surgery is there to prevent, and it is also why I want to see a child again if drops alone are not keeping the eye comfortable, rather than let months pass on a plan that is not actually working.
Do the lashes need to be plucked or trimmed?
No. Plucking or cutting the lashes at home does not treat the fold of skin causing the problem, and it is not something I recommend. The lashes grow back pointing the same way, because the tissue underneath them has not changed. All it adds is a sore lid and a child who now associates their eyes with being pulled at.
If your child's lashes are stiff enough that they are visibly scratching the eye, the right next step is lubricant, a review with your doctor, and a decision about surgery if it is needed, not scissors at the bathroom sink.
Is this the same as when an adult's eyelid turns in?
No, and the difference is exactly why children so often grow out of this and adults with a similar-looking eyelid usually do not. In a child with this fold, the lid margin itself is in the correct position and the extra skin is what tips the lashes inward. In an adult whose eyelid margin rotates inward, the margin has actually turned, which is a different condition called entropion, and it does not resolve by itself the way a child's soft-tissue fold can. If you are an adult reading this because your own lower lid has started turning in, my colleague Dr Catherine Chow, a consultant oculoplastic surgeon, deals with that properly in her piece on an eyelid that turns inward in an adult, and why it is not simple irritation.
I mention it because parents sometimes assume their child has "the same thing grandma had done", and it usually is not. Two eyelids can look similar from across the room and be doing something quite different underneath.
What should I actually do while we wait and watch?
Use lubricant drops or ointment as advised, keep an eye out for redness, rubbing, or excessive watering, and book a review rather than assuming it has quietly gone away. A child whose eye stays comfortable and whose lashes are still soft can usually just be watched, with a check every so often as they grow.
If the eye becomes persistently red, if your child seems bothered by light, or if you notice a scratch mark or constant rubbing, that is worth an earlier look rather than waiting for the next scheduled visit. A red or irritated eye also has other, entirely separate causes, and if it comes with sticky discharge or spreads to both eyes quickly, pink eye in children is worth reading alongside this one. Most families I see for inturned lashes leave with a bottle of lubricant and a plan to check back in a few months, nothing more dramatic than that, and for most children that turns out to be exactly enough.
- The white of the eye looks persistently red or irritated, not just occasionally.
- Your child is unusually sensitive to light or squints hard outdoors.
- There is any cloudiness, a visible scratch mark, or your child rubs one eye constantly.
- The eye is watering so much it runs down the cheek, day after day.
- You notice the lashes catching or your child blinking hard, especially while reading or looking down.
Common questions
My child's bottom lashes are touching her eye, is that a problem?
Do the lashes need to be plucked?
Why does he blink so much when he looks down at a book?
Will she need an operation for inturned lashes?
Is this the same as when an adult's eyelid turns in?
Could this be why my child's eye is always watery?
Should I be worried it will scar her eye?
- AAPOS · Epiblepharon · aapos.org
- NHS · Eyelid problems · www.nhs.uk
- NHS · Watering eyes · www.nhs.uk
- NHS · Dry eyes · www.nhs.uk