Epicanthal Folds

Overview

Epicanthal folds are folds of skin that run from the upper eyelid down to the inner corner of the eye, partly covering the area where the upper and lower lids meet. They give the inner eye a slightly rounded or covered appearance.

Epicanthal folds are extremely common and are a completely normal feature in many people, particularly those of East Asian and certain other backgrounds, and in many young children whose facial bones are still developing. In most cases they have no medical significance at all. Less commonly, when they appear together with other distinctive features, growth differences, or developmental concerns, they can be one part of the picture of a genetic or developmental condition. The folds reflect the shape and development of the eyelids and the bridge of the nose, which is why they are common in babies and often soften as a child grows. Taken alone, in a healthy and normally developing child, they are simply part of that person's appearance.

Common Causes

Epicanthal folds can be present for several reasons:

• Normal variation: By far the most common reason. They are a normal, inherited feature in many populations and are common in infancy and early childhood.
• Developing facial structure: In young children, folds often become less noticeable as the nose bridge grows.
• Genetic conditions: Such as Down syndrome and some other syndromes, where they appear with other features.
• Fetal alcohol spectrum disorders: Epicanthal folds can be among the features seen with fetal alcohol syndrome.

By themselves, epicanthal folds are usually not significant.

Associated Symptoms

When epicanthal folds are part of a condition, they may appear with other features:

• Other distinctive facial features, such as small eye openings, a smooth philtrum, or a thin upper lip
• Developmental delay or learning difficulties
• Low birth weight or slow growth
• A small head size (microcephaly)
• Other physical features specific to a particular condition

Diagnosis & Evaluation

Epicanthal folds are noted during a routine examination. A doctor considers whether they are an isolated, normal feature or appear alongside other signs that warrant further assessment.

• Facial and physical examination: Looking for other distinctive features.
• Growth and development review: Checking weight, length, head size, and milestones.
• Specialist or genetic assessment: If a genetic or developmental condition is suspected.
• Eye examination: If the folds affect the eyelids or vision.

Treatment & Management

Epicanthal folds usually need no treatment, as they are most often a normal feature.

• No action needed: When they are an isolated, normal variation, only reassurance is required, and they often become less noticeable as a child grows.
• Managing any underlying condition: Care and support are directed at the specific condition if one is identified.
• Developmental and educational support: Where a condition affects growth or learning.
• Eye care: Rarely, if the folds affect the eyelids or vision, an eye specialist can advise.

Self-Care & Prevention

Epicanthal folds are most often a normal, inherited feature that cannot and need not be prevented. There is usually nothing to do beyond reassurance, and they often become less noticeable as a child grows. A few general points are helpful:

• Attend routine checks: Regular child health and development reviews allow any associated features to be picked up early if a condition is present.
• Keep eye checks up to date: An eye examination ensures vision is developing well, especially if the folds are prominent.
• Avoid alcohol in pregnancy: Because epicanthal folds can occasionally form part of fetal alcohol spectrum disorders, avoiding alcohol during pregnancy supports healthy development.

Where the folds are simply part of a child's normal appearance, no treatment or special care is needed.

When to See a Doctor

Epicanthal folds on their own are usually not a concern. See a doctor if they appear together with:

• Other distinctive facial features
• Slow growth, a small head size, or low birth weight
• Delayed milestones, learning difficulties, or developmental concerns
• Any concern about the child's eyes or vision

In these situations, a medical assessment can determine whether further evaluation is helpful and ensure any support is started early.

Related Topics

Frequently Asked Questions

References

1. MedlinePlus, U.S. National Library of Medicine. Epicanthal folds.
2. Centers for Disease Control and Prevention (CDC). Facts about Down Syndrome.
3. Centers for Disease Control and Prevention (CDC). Fetal Alcohol Spectrum Disorders (FASDs).