The epicanthus or epicanthal fold is the excess of skin folds on the concave of the eyelid and the half-moon-shaped skin fold that covers the inner part of the eye called the canthus.
The epicanthal fold obscures the view of the medial canthus, including the caruncle and plica semilunaris. This is the most common congenital eyelid condition.
Epicanthus may be an isolated phenomenon or an associated feature in patients with congenital ptosis, Down syndrome or blepharophimosis syndrome.
The condition may be unilateral or bilateral and is most prominent along the upper eyelid. Although it is a normal finding in people of Asian descent, it is abnormal in non-Asians.
The causes of epicanthus lead to the appearance of false strabismus. This condition does not pose any problem for the eye. However, it causes parental concern because of its similarity to pseudoesotropia.
Gentle stretching of the soft tissues of the nasal bridge reduces the appearance of the epicanthus in the medial canthus and reveals normal alignment of the eyes.
The covering and cross-covering test reveals orthophoria.
Depending on the origin and configuration of the free fold, there are at least four different types of epicanthus.
Epicanthus inversus is often seen in association with blepharophimosis and may be associated with relative skin distress in the lateral periorbital region.
Epiblepharon, a related condition more common in Asians, occurs when a skin fold runs the entire length of the lower eyelid just below the eyelashes, causing irritation of the eyes, causing them to turn inwards.
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The causes of epicanthus are mainly due to a relative lack of skin on the vertical axis within the medial canthal region.
It can occur alone or in association with other abnormalities.
The diagnosis of epicanthus is clinical and depends on the origin and configuration of the free fold.
Supraciliaris : Formed when the free fold begins at the midpoint of the eyebrow, flows to the lateral aspect of the nostril and ends over the anterior lacrimal crest. It conceals the medial canthus and caruncle.
Palpebralis : Similar to the epicanthus supraciliaris, except that the fold arises from the tarsal region of the upper eyelid and flows downwards over the medial canthal region and ends at the anterior lacrimal crest.
Tarsalis : This normally occurs in Asians, the epicanthal fold extends along the length of the upper eyelid, hides the roots of the eyelashes and ends in a fold in the medial canthus. It may not cover the medial canthal structures and caruncle.
Inversus : It occurs when the fold in the middle eyelid arises in the lower eyelid and runs upwards, closing the medial canthus angle and ending in the upper eyelid, which may or may not be affected. The shape of the palpebral fissure is quadrangular instead of elliptical.
Lazy eye is rare in association with Epicanthus and is usually associated with other problems such as anisometropia and astigmatism.
No spinal abnormalities have been reported in patients despite compensatory head tilt for drooping eyelids.
These articles are written for informational purposes. You should consult your doctor to determine whether the procedure is performed and the appropriate treatment for you.
