Epicanthal folds

What are Epicanthal Folds?

January 31, 2017
Epicanthic fold is the skin fold of upper eyelid which covers the inner corner of eye. Elevation of nose bridge is the closely related facial feature of epicanthic folds. Epicanthic folds is commonly seen in chinese. It may occur due to age or ancestry or other medical conditions. Japanese are also common with epicanthic fold eyes. Epicanthus eye fold, mongolian folds and palpebral nasal folds are other names of epicanthic folds. Mostly children with epicanthic folds lose these folds after 3 to 6 months of gestation period.

There are many factors which clearly and directly affect epicanthic folds. As geographical distribution shows areas having people with epicanthic fold eyes. In korea. Japan and china it is most common. Some people think that epicanthic folds develop due to excessive pig eating. It is a congenital abnormality and present by birth. Commonly patients dawn syndrome are found with epicanthic folds. Scientists said so because patients with Dawn syndrome show similarity with blumenbach’s mongolian race.

They both have epicanthic folds. Epicanthic folds are also present in people with zellweger syndrome. Epicanthic folds can also occur due to fetal alcohol syndrome, turner syndrome and phenylketonuria. These epicanthic folds are usually bilateral and involve both upper and lower eye lids. During fetal development, the upper eyelid skin become excessively developed across the nose bridge.

There are 4 main types of epicanthic folds according to the area of eye involved:

Epicanthus tarsalis. (It involve over development of upper eyelid.)
Epicanthus inversus (it involve over development of lower eye lid)
Epicanthus palpebralis (it involve both upper eye lid and lower eye lid)
Epicanthus superciliaris (in this type, whole eye is involved from upper eye brow to lower & lacrimal sac)

According to these types, their etiology is also different. Like epicanthus inversus is associated with blepharophemosis. Children who have prominent epicanthic folds are considered esotropic and leads to pseudostrabismus. The degree of caruncle obscuration shows the severity of epicanthic fold. So epicanthic folds are graded as mild, moderate and severe epicanthic folds. In mild epicanthus, less than half part of caruncle is covered, in moderate epicanthus half part of caruncle is covered and in severe epicanthus, whole caruncle is covered with epicanthic fold. In epicanthic folds, surface tension of skin is decreased and leads to tighten skin and this decrease in surface tension occur due to ectopic orbicularis muscle fibers of oculi and connective tissue.

A surgery is required to treat epicanthic folds. In surgery the core part of epicanthus is removed. Basically epicanthus consist of 3 main layers i.e. an outer layer, middle one and inner core. And inner core is treated for epicanthic folds. Surgery is not required in most of the cases. In children, epicanthic folds disappear on its own with the passage of time. Surgery is required only when epicanthic folds do not disappear with time. Treatment is not difficult and epicanthic folds are not pathogenic. So, if these epicanthic folds are left untreated, it will not cause further serious complications.