To determine a classification system for epiblepharon of the lower eyelid and to evaluate a possible correlation between lower lid epiblepharon and astigmatism. Three morphologic characteristics (skin fold, cilia touching the cornea and corneal erosion) were observed by slit-lamp biomicroscopic examination and Polaroid pictures in 186 eyes of 102 patients with epiblepharon of the lower lid. In 112 eyes, cycloplegic refractions performed. A classification system reflecting the severity of epiblepharon was then sought, and the incidences and type of astigmatism were evaluated. Epiblepharon of the lower lid could be classified according to the height of skin fold, the area of cornea touched by cilia and the area of corneal erosion. There was significant agreement between these three classifications. The incidence of astigmatism of 0.5D or more was 54%; most was 'with-the-rule', regardless of a patient's age. In addition to the representative nature of other characteristics, skin fold height can be easily measured without the need for slit-lamp examination in children and is closely related with the amount of skin which should be excised during surgery to correct epiblepharon. A classification system using skin fold height may therefore be the most appropriate method. In addition, there may be a correlation between lower lid epiblepharon and astigmatism.