INTRODUCTION Epicanthal folds are small webs of skin that contour around the medial canthal region. They can be seen as an isolated finding or in association with other facial anomalies such as the blepharophimosis syndrome or Downs syndrome. They can also be seen as a racial variation, particularly in some East Asian and Southeast Asian eyelids, and in Native Americans and the Khoisan of Southern Africa. They can also be seen in young children as a normal finding before the nasal bridge elevates. Epicanthal folds are categorized by anatomic location, and are termed epicanthus inversus, e. palpebralis, e. tarsalis, and e. supraciliaris.
CLINICAL CHARACTERISTICS Epicanthal folds vary from hardly noticeable to very strongly developed.
They usually diminish with age as the nasal bridge changes in height and contour. In epican-thus inversus the fold of skin takes origin from the lower eyelid and extends to the medial canthal angle, covering the canthal angle and caruncle. It confers a rounded contour to the lower eyelid, and the fold often obscures the lid margin medially. It may be associated with a limited from of epiblepharon. In epicanthus palpebralis the skin fold extends from the tarsal region of the upper lid to the margin of the lower lid, giving an abnormal contour to the upper eyelid margin. This type tends to improve with growth of the midface. Epicanthus tarsalis is a fold that extends from the pretarsal upper eyelid skin to the medial canthal angle, and is a normal finding in the Asian eyelid. In epicanthus supraciliaris the fold originates from just below the medial eyebrow and extends to the medial canthus in the region of the lacrimal sac.
TREATMENT Epicanthal folds are usually only of cosmetic importance, but in some cases they may obscure the medial visual field. When correction is indicated the treatment is surgical. Many different procedures are available, but all rely on tissue rearrangement to lengthen the vertical component of the fold at the expense of the horizontal width. These include the modified Y to V plasty, the Z-plasty, and combinations of Z-plasty and Y to V rearrangements.
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