These are vertical skin folds over the inner or medial angle of the eyelids.
They are normal during foetal development from the third to sixth month. In Caucasians, they are rarely seen after birth but in mongolian races, they persist into adult life. Caucasian children with epicanthic folds often have a broad flat nose with widely separated eyes. There may appear to be a convergent squint.
In epicanthus tarsalis, the superior lid fold is continuous medially with the epicanthal fold; in epicanthus inversus, the skinfold blends into the lower lid.
Examination for suspected squint shows that the eyes are straight. The squint can be made to disappear by pinching up the loose skin over the bridge of the nose.
The condition results from a lack of vertical skin between the canthus and the nose. In Caucasians, the epicanthus often disappears at puberty or before as the nose develops. In more severe cases, surgical correction aimed at vertical lengthening and horizontal shortening may be beneficial.
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