Epicanthal folds are a common facial feature, referring to a fold of skin from the upper eyelid that covers the inner corner of the eye (medial canthus). While often temporary in infants, their presence leads to questions about whether they change or diminish over time. This article explores the nature of epicanthal folds and their developmental trajectory.
What Are Epicanthal Folds?
Epicanthal folds are skin folds of the upper eyelid that extend over the inner corner of the eye, obscuring the tear duct area. This anatomical feature is not related to vision quality or eye health. The fold’s prominence can vary, ranging from subtle curves to more defined crescents that shape the eye’s contour.
These folds are a common characteristic found across diverse populations. They are notably prevalent in individuals of East Asian, Southeast Asian, Central Asian, and North Asian descent, with a high frequency among these groups. Epicanthal folds also appear in Indigenous peoples of the Americas, some African populations, and at lower frequencies in certain European groups.
Do Epicanthal Folds Change Over Time?
Epicanthal folds frequently become less noticeable or diminish entirely as a child grows and their facial structure matures. This change is primarily linked to the development of the nasal bridge. As the nose grows and becomes more prominent, the skin of the mid-face is stretched, which can reduce the appearance of the fold.
Many fetuses exhibit epicanthal folds, which often recede during the later stages of gestation or shortly after birth. For infants, these folds are often a temporary feature, and they commonly resolve as the child’s facial features mature, typically between the ages of three and five years.
Epicanthal Folds vs. Pseudostrabismus
Epicanthal folds can create the optical illusion of crossed eyes, a condition called pseudostrabismus. This occurs because the skin fold covers a portion of the white part of the eye (sclera) near the nose, making it appear as though the eye is turning inward even when it is straight. This appearance is especially noticeable in photographs or when a child looks to the side. Pseudostrabismus is common in infants and toddlers due to their wide, flat nasal bridges and broad epicanthal folds.
It is important to distinguish pseudostrabismus from true strabismus, a misalignment of the eyes. True strabismus can lead to vision problems if not addressed. A simple method to observe the difference involves shining a light directly into the child’s eyes: if the light reflects in the same spot on both pupils, it suggests pseudostrabismus. If reflections are in different locations, it may indicate true strabismus, necessitating a professional eye examination. Pseudostrabismus does not require treatment and improves as facial features develop.
When to Consult a Doctor
In most instances, epicanthal folds do not require medical intervention. However, specific situations warrant consulting a healthcare provider. A medical evaluation may be recommended if epicanthal folds are accompanied by other unusual physical characteristics or developmental delays.
Asymmetry in the folds or any concern regarding a child’s vision, such as true strabismus, warrants a professional assessment. For non-Asian infants, if epicanthal folds are noted, a healthcare provider might examine for other signs that could suggest an underlying genetic condition. A doctor can differentiate between a normal variation and a feature indicating a broader medical condition.