This single centre review was conducted over 15 years to determine the frequency, indications and long-term follow-up of those referred for surgery as well as those treated conservatively for epiblepharon. Eighty-nine patients aged two months to 14 years (mean age 31 months) were reviewed; 76 had bilateral epiblepharon and 61 had tearing, discharge, conjunctival infection or eye rubbing. Trichiasis was noted in 15 patients. Many had no symptoms and eyelid deformity was detected on ophthalmic examination. Initial treatment was conservative for 73 patients with antibiotic ointment or tear substitutes – observation only was provided for 16 patients. Forty-eight patients had follow-up and only three required surgery. Symptoms completely resolved for 94% of patients treated conservatively.