Introduction
Epicanthal folds or monolid eyes are commonly observed eyelid shapes in people of Asian descent. It can also occur due to genetic reasons. They can be present either from birth or can develop during the growth process as the person ages. Epicanthal folds describe the shape of an eyelid. The reason for Asian people to have epicanthal folds is not clearly understood. Some theories state that it acted as an adaptive advantage for the ancient Asians who were living in windy and cold climates. Sometimes epicanthal folds are formed due to the excessive development of the skin over the bridge of the nose.
What Are Epicanthal Folds?
Epicanthal folds are skin folds that extend from the upper eyelid to the medial canthus (inner corner) of the eye. These folds can run from the nose to the inner part of the eyebrow. People with epicanthal folds seem to have smaller eyes as they do not have folds or creases separating the eyelid into two sections. Epicanthal folds often reduce the opening between the upper and lower eyelids In many children, epicanthal folds are seen before the development of the bridge of the nose. Mostly monolid eyes or epicanthal folds are considered a harmless trait.
What Are the Types of Epicanthal Folds?
There are four types of epicanthal folds. They are as follows:
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Epicanthus Tarsalis: People with this type of epicanthus have the fold prominent throughout the upper eyelid.
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Epicanthus Inversus: People with epicanthus inversus have a prominent skin fold along the lower eyelid.
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Epicanthus Palpebralis: People with epicanthus palpebralis have folds along both the upper and lower eyelids.
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Epicanthus Supraciliaris: In the epicanthus supraciliaris type, the fold begins from the brow and travels down to the lacrimal sac.
What Are the Causes of Epicanthal Folds?
Epicanthal folds are caused due to genetic reasons. More than 50 percent of the Asian descendants have epicanthal folds. They are also seen before the development of nose bridges in young children of non-Asian races. Some genetic conditions have epicanthal folds as a characteristic feature. The conditions are as follows:
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Down Syndrome: Down syndrome or trisomy 21 is a genetic disorder in which people are born with an extra chromosome. People born with this genetic condition have developmental delays, heart conditions, and unique physical traits like epicanthal folds.
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Fetal Alcohol Syndrome: Fetal alcohol syndrome is a condition that is seen in a child who has been exposed to alcohol due to the drinking habit of the mother during pregnancy. The child can have both physical and cognitive defects. The peculiar facial features include small eyes with epicanthal folds, an upturned nose, a thin upper lip, etc.
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Turner Syndrome: It mainly affects females and people with this syndrome have one of their X chromosomes missing. People with Turner’s syndrome can have developmental delays.
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Williams Syndrome: A part of chromosome 7 is seen missing in people with Williams syndrome. People with this syndrome can have developmental delays, learning problems, and unique facial features like prominent lips, flat noses, and epicanthal folds.
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Noonan Syndrome: Noonan syndrome is caused due to mutations (changes) in multiple genes. Affected people can have heart problems and unique facial features like eyes that slant down and wrap along the sides of the face.
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Triple X Syndrome: An extra X chromosome is present in people with this syndrome. This disorder is also known as trisomy X syndrome.
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Zellweger Syndrome: Zellweger syndrome is caused due to the changes in PEX genes. People experience problems related to metabolism and the nervous system.
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Blepharophimosis Syndrome: Blepharophimosis syndrome is associated with changes in the FOXL2 gene. The common characteristic features are eyelid problems like narrow eye-opening and eyelids that are droopy.
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Rubinstein-Taybi Syndrome: People with this disorder have features like intellectual disabilities and short stature with big thumbs and toes.
What Are the Treatment Options for Managing Epicanthal Folds?
The options for managing epicanthal folds can be divided into invasive and non-invasive techniques. They are as follows:
1 . Non-invasive Techniques: Usually, epicanthal folds do not require treatment as they are harmless. But people who have aesthetic concerns have certain non-invasive options to get rid of them. But the non-invasive techniques are only a temporary solution. They are as follows:
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Adhesives: This is a non-invasive treatment option of using tapes or special glues to create artificial creases in the eyelids. Adhesives can give the appearance of double eyelids.
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Makeup: Natural-looking creases can be added to hide the epicanthal folds using makeup. Tips and tricks in makeup application can make the eyes look bigger. Applying bright-colored eye shadows is a common technique that can hide epicanthal folds. Using eyeliners and eyeshadows to highlight and pop up the narrow eyes can also hide epicanthal folds.
2 . Invasive Techniques: Invasive techniques involve bringing permanent change to the eyelids using plastic surgery. Plastic surgery is not a necessary treatment option. But it depends on the patient’s choice. The two types of surgical procedures used for correcting epicanthal folds are as follows:
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Blepharoplasty: Blepharoplasty is an eyelid surgery that can permanently transform epicanthal folds. This surgery removes the excess fat or skin and enhances the appearance of creases in the eyelids. The surgeon ensures that the creases stay in place with the eyelid. Blepharoplasty combined with ptosis surgery can give a wide-eyed appearance and strengthen the eyelid muscle.
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Epicanthoplasty: Epicanthoplasty is a surgical procedure that makes the eyes look bigger by lengthening the inner corners of the eyes. During this procedure, the inner corners of the eyes are extended towards the eyes.
Conclusion
Epicanthal folds can have both medical and cultural significance. Epicanthal folds are a normal trait seen in babies of Asian origin. However epicanthal folds seen in non-Asian babies should be checked for genetic disorders like Down syndrome, William’s syndrome, etc. Epicanthal folds that are not a part of any genetic disorder are harmless. There is no need to worry about the epicanthal fold and one should learn to embrace it. Only people who are bothered and do not feel confident about the appearance of their eyelids can undergo surgery. Hence epicanthal folds should not be considered an abnormality, instead, they should be treated as a natural aspect of human diversity.
