Epicanthal Folds Treatment

January 27, 2017

Epicanthic folds consist of skin folding of upper eyelid. Mostly upper eyelid is involved but it can sometimes involve lower part of eye too. It is normally found in Chinese, Korean and Japanese. In children, it can disappear on its own after 3 to 6 months of gestation period. Symptoms appear according to the part of eye involved in it. When epicanthic folds do not disappear on its own then treatment is required. Treatment should be started under the supervision of a professional medical practitioner. Surgical therapy in rarely used in patients. It is performed in case of simple epicanthic folds.

When patient need spontaneous result then surgery is recommended to set facial features i.e. nasal bridge and mid face. Surgery also resolves pseudo strabismus. Epicanthic folds appear when there is abnormal skin folding due to mal distribution of skin. This mal distribution of skin occur due to hypertrophy or kinking muscle fibers of orbicularis oculi in medial canthus. This is the round orbital portion of eye which is present on the tendon of medial canthus rather than nasal. It is also possible that superior part of medial horn of the levator palpebral got abnormally attach to the anterior part of medial canthal tendon in upper eyelid.

Surgical therapy is not recommended in patients below 5 years of age. This surgery is a non reversible procedure. So patient is asked to understand the ramifications of this procedure because it may affect patient’s heritage. Parents are advised to wait until their child reach to the age of puberty. In this surgery, there is a choice between local and general anesthesia. Its selection depends upon the age of patient. The surgical procedures according to type and severity of epicanthic folds are as follows:

Verwey’s “Y V” operation: in this surgical procedure, the moderate type of epicanthic folds are treated.

Mustarde double z-plasty: it is considered a least satisfactory procedure for epicanthic folds. This procedure is performed only in severe cases of epicanthic fold.

Roved a’s procedure: it is also known as roved a’s five flap technique. In this procedure, the broader epicanthic folds are treated and excellent results are obtained.

Spaeth’s inverted V operation: this procedure is considered safe for mild type of epicanthic folds. It is the simplest and most effective surgical procedure.

Pang’s eyelid crease procedure: in this procedure, a full thickness fibrous tracts are produced in eyelids. It is an eye crease procedure. These fibrous tracts leads to joining of superior tarsal border with skin. In this procedure, crease level is obtained again which was lost after ptosis surgery. It is performed especially when the creases are asymmetric. This technique is also useful as a cosmetic operation in westernize the Asian eyelids.

In most children, epicanthic folds disappear after puberty and there is very less ratio of patients preferring surgery. Surgical therapy is considered the most successful treatment option of epicanthic folds. Most of the patients ask their physician about surgery for spontaneous results.