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Epicanthal folds: Something to be aware of

Children of all races, including infants and young children, exhibit epicanthal folds, and Asians of all ages exhibit them as a normal finding. It appears that in many cases, the formation of these folds is associated with excessive tension in the underlying muscle. Many surgical techniques are available to correct, but many leave unsightly scars due to the procedures.

Types of Epicanthal Folds:

Epicanthal Folds come in a variety of types:

  • Epicanthus supraciliaris :

Unusually for a facial fold, epicanthus supraciliaris is a vertical fold of skin that extends from below the brow to an area just above the infraorbital rim, typically obscuring the caruncle.

  • Epicanthus palpebralis:

Except for the fact that it begins lower in the tarsal region of the upper eyelid and travels down across the medial canthal region, it is quite similar to the epicanthus supraciliaris. It terminates at the area of the anterior lacrimal crest.

  • Epicanthus tarsalis:

For eyelid conditions, epicanthus tarsalis is a scientific term for a fold that originates laterally and spreads over the entire eyelid before terminating the canthus. Typical upper lid configuration in Asia is as follows: A true superior palpebral fold does not exist in the upper lids of epiblepharon, as does epicanthus tarsalis. Instead, a fold of skin extends beyond the eyelid margin and pres against the cornea, differentiating it from epicanthus tarsalis.

  • Epicanthus inversus:

It’s similar to epicanthus tarsalis in that it involves the lower lid. Still, it’s different in that it involves the lower eyelid. It occurs as part of Komoto’s tetrad, which includes blepharoptosis, blepharophimosis, telecanthus, and epicanthus inversus; blepharophimosis is the narrowing of the palpebral aperture in its horizontal dimension; telecanthus and epicanthus inversus is the narrowing of the palpebral aperture in their vertical dimension.

Treatments that one can follow

  • Surgical Procedures are used in some cases to treat certain conditions. Simple epicanthal folds is a condition for which surgery is rarely suggested since it usually cures on its own when the nasal bridge and mid-face mature. Along with this, the pseudostrabismus is also resolved.
  • Before the age of five years, people should never consider preventive repair. They should allow it for natural regression throughout this period. If Asians are hurried into epicanthal fold restoration before realizing the consequences of a non-reversible operation that negatively reflects their cultural background, they should reconsider. Following the patient’s age, surgery may be performed under local anaesthesia or general anaesthesia.
  • A technique known as Pang’s eyelid crease treatment is utilized to create full-thickness fibre tracts in the lids by creating creases in the lids. The superior tarsal border and the skin become adherent as a result of this. It may be necessary to do this operation following ptosis surgery to adjust the crease level, particularly if the creases are asymmetrical. Sometimes employed as a cosmetic procedure to “westernize” the Asian eyelids, this procedure is known as “eyelid lift.”


After reaching adolescence, the vast majority of youngsters of Asian descent lose their folds. The majority of instances with epicanthal folds are successfully treated surgically.

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