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Epicanthic Fold

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What is an Epicanthic Fold?

Epicanthic fold is also known as epicanthal fold. It is the fold of skin across the inner corner of the eye (also called canthus). The epicanthic fold will produce the eye shape characteristic of persons from eastern and central Asia; also, it is seen in a few Native American peoples and occasionally in Europeans (for example, Poles and Scandinavians).


Differentiation in the shape of epicanthic fold has led to 4 types being recognized as given below:

  • Above the upper tarsus, Epicanthus palpebral begins to the inferior orbital margin.

  • Epicanthus supraciliary runs from the brow, by curving downwards towards the lachrymal sac.

  • Epicanthus inversus usually runs from the lower eyelid skin over the medial canthus and also extends to the upper lid.

  • Epicanthus tarsalis usually originates at the upper eyelid crease and it merges into the skin near the medial canthus. This is the most often type found in East Asians.

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Ethnogeographic Distribution

High-Frequency Populations

Southeast Asians, East Asians, North Asians, Central Asians, Micronesians, Native Americans, Polynesians, Mestizos, Khoisans, and Malagasy have the highest prevalence of epicanthic folds. Among the South Asians, they take place at very high frequencies among the Bhutanese, Kirati, and certain Adivasi tribes of eastern India and Northeast Indians.

In fewer of these populations, the trait is mostly universal, particularly in Southeast Asians and East Asians, where a majority, up to 90 percent in a few estimations, of adults contain this feature.

Lower-Frequency Populations

Epicanthic folds also occur in other populations, though at a much lower frequency: Europeans (for example, Scandinavians, English, Hungarians, Irish, Poles, Russians, Lithuanians, Estonians, Latvians, Finns, and Samis), South Asians (Bengalis, Sinhalese among other groups in eastern South Asia), Cushites, Nilotes, and Amazigh people.

Perception and Attribution

The development degree of the fold between individuals differs greatly, and attribution either of its absence or presence is often subjective, being to the degree relative to the occurrence of the trait within the community of the particular observer. In addition, its frequency differs clinically across Eurasia. Therefore, its use as a phenotypic marker to describe the biological populations is debatable.

Possible Evolutionary Function

The epicanthic fold is frequently linked to increased fat deposition around the eyeball, which is particularly noticeable in native North Siberian, Inuit, and Aleut populations. The adipose tissue is thought to provide greater insulation for both the eye and sinuses from the effects of cold, especially from the freezing winds, and to represent an adaptation to cold climates. 

Also, it has been postulated that the fold itself can provide a protection level from snow blindness. Though its appearance in the peoples of Southeast Asia may be linked to the possible descent from cold-adapted ancestors, its occurrence in different African peoples precludes the cold-adaptive explanation for it appearing in the latter groups. The epicanthic fold found in fewer African people has been tentatively linked to protection for the eye from the levels of high ultraviolet light, which is found in semi-desert and desert areas.


Epicanthal folds can be normal for people of Asiatic descent and a few non-Asian infants. Also, epicanthal folds can be seen in young children of any race prior to the nose bridge beginning to rise.

Also, however, they can be due to certain medical conditions, including the below-given ones:

  • Fetal alcohol syndrome

  • Down syndrome

  • Phenylketonuria (PKU)

  • Turner syndrome

  • Noonan syndrome

  • Williams syndrome

  • Blepharophimosis syndrome

  • Rubinstein-Taybi syndrome

Other Factors


Several fetuses lose their epicanthic folds after 3 - 6 months of gestation. Epicanthic folds can be visible in the development stages of young children of any ethnicity, especially before the nose bridge fully develops.

Etiology of Epicanthic Fold

Cadaver specimens with the epicanthal folds have represented a connection between the lower and upper preseptal orbicularis muscle fibers. This was not evident in the specimens without the epicanthus.

Medical Conditions

In some cases, such as in Zellweger syndrome and Turner syndrome, the presence of epicanthic folds can be a sign of congenital abnormalities. Medical conditions, which cause the nasal bridge not to develop and project are associated with the epicanthic fold. Up to 60 percent of individuals with Down syndrome (also called trisomy 21) have prominent epicanthic folds. In the year 1862, John Langdon Down classified what is now known as Down syndrome.

He used the word mongoloid for the condition. This particular theory was derived from then-prevailing ethnic theory and from his own perception that children with Down syndrome shared physical facial similarities (epicanthic folds) with those of Blumenbach's Mongolian race. While the word "mongoloid" (also "mongoloid idiot" or "Mongol") continued to be used until during the early 1970s, it is now considered pejorative and inaccurate and no longer in common use since the 1970s about such types of medical conditions. Also, in Zellweger syndrome, epicanthic folds are prominent. The other examples are phenylketonuria, fetal alcohol syndrome, and Turner syndrome.

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FAQs on Epicanthic Fold

1. Give the Etiology of Epicanthic Fold?

Answer: Tension on the skin's medial canthus is caused by the connective tissue and ectopic orbicularis oculi muscle fibers. It results in residual horizontal skin over the bridge of the nose, as well as vertical tension due to a lack of redundant vertical skin in the area. Therefore, correcting the fold lies in reducing the tension, which is placed on the skin by the fibers of ectopic orbicularis. And, cadaver specimens with the epicanthal folds have represented a connection between the lower and upper preseptal orbicularis muscle fibers. This was not evident in the specimens without the epicanthus.

2. What is the General Treatment of Epicanthic Fold?

Answer: Surgical correction is needed only occasionally. Frequently a mild degree of the epicanthus can be observed in children and is normally temporary as the folds disappear with the further development of the mid-facial bones and nose. Generally, the observation is recommended until the maturation of the face if no other eyelid abnormalities are present. But, the epicanthus inversus rarely resolves with the growth and will typically require surgical correction.

3. Explain the Surgical Treatment Epicanthic Fold?

Answer: Typically, surgical treatment for most of the isolated epicanthus is achieved with transposition flaps, such as a Z-plasty or Y-V-plasty. Epicanthus tarsalis can be treated with subcutaneous epicanthoplasty, Y-V-plasty, or a modified Z-plasty that includes the formation of an upper lid crease in Asian patients.

4. How Common are Epicanthic Folds?

Answer: Epicanthic fold is most common and may be found in over 90 percent of the East Asians (Japanese, Chinese, Mongolians, Koreans, and several other ethnic groups), and the further we go from the area, the folds' frequency becomes lower. Also, the areas that have a high frequency of epicanthic folds are North Asia, Southeast Asia (referring to parts of Siberia) within the Asia regions.

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