An epicanthus or epicanthal fold is a vertical or oblique skin fold of the upper eyelid that covers the inner corner of the eye and runs from the nose to the inner side of the eyebrow.
There are four types of epicanthal fold:
- straight (tarsalis), which is most prominent on the upper eyelid;
- inversus, which is most prominent along the lower eyelid;
- palpebralis is equally prominent on the upper and lower eyelids;
- superciliaris starts from the eyebrow and reaches the zone of projection of the lacrimal sac.
Epicanthus causes
Epicanthus is normally found in Asians (tarsalis variant) and young children of any race before the period of elevation of the bridge of the nose.
However, epicanthic folds can be associated with some hereditary syndromes and diseases. These include:
- Down syndrome;
- Turner syndrome;
- Williams syndrome;
- fetal alcohol syndrome;
- Noonan syndrome;
- Rubinstein-Taybi syndrome;
- phenylketonuria;
- Blepharophimosis syndrome (inversus epicanthus).
Therefore, Caucasian children who are found to have epicanthus after birth need additional screening for genetic diseases.
Epicanthus symptoms
The main complaint of patients is a cosmetic defect. Also, the epicanthus can be accompanied by ptosis (drooping) of the eyelids, pseudo-squint, and shading of the visual axis, which cause discomfort and visual impairment. There may be a disturbance of the outflow of the lacrimal fluid (tearing) and lagophthalmos (the inability to fully close the eyelids) in rare cases.
Epicanthus diagnostics
Diagnosing epicanthus is not difficult. The doctor diagnoses the problem by visual and slit-lamp examination.
Correction of Epicanthus
If epicanthus does not cause psychological discomfort and severe symptoms, it does not require treatment. Often the epicanthus disappears on its own in adolescence as the nose and face bones develop. But an inverse epicanthal fold rarely goes away on its own.
It is possible to eliminate the epicanthus only by surgery. A Y-V or Z blepharoplasty is performed.
In Asians, subcutaneous epicanthoplasty, Y-V-plasty, or modified Z-plasty with the formation of the upper palpebral fold are used
Frequently Asked Questions
What is an epicanthus?
An epicanthus, or epicanthal fold, is a skin fold of the upper eyelid that covers the inner corner of the eye. It runs from the nose to the inner side of the eyebrow and can vary in prominence depending on its type.
What are the types of epicanthal folds?
There are four types of epicanthal folds: straight (tarsalis), inversus, palpebralis, and superciliaris. Each type differs in its location and prominence on the eyelids.
What causes epicanthus?
Epicanthus is typically found in Asians and young children of any race before their noses develop. It can also be associated with various hereditary syndromes and diseases, requiring additional screening in certain cases.
What symptoms are associated with epicanthus?
The main symptom is a cosmetic concern, but it can also be accompanied by eyelid drooping, pseudo-squint, and visual impairment. Rarely, it may cause tearing issues and difficulty closing the eyelids.
How is epicanthus diagnosed?
Diagnosing epicanthus is straightforward and is done through visual and slit-lamp examination by a doctor.
Is treatment necessary for epicanthus?
If epicanthus does not cause significant discomfort or severe symptoms, treatment may not be needed as it can resolve on its own during adolescence. However, surgical options are available for those seeking correction.
What surgical options are available for correcting epicanthus?
Surgical correction of epicanthus can be performed using techniques like Y-V or Z blepharoplasty. In Asians, subcutaneous epicanthoplasty or modified Z-plasty may be used to form the upper palpebral fold.
