epicanthus
Epicanthus is a vertical fold of skin that runs from the upper or lower lid toward the medial canthus, usually on both sides.1 In infants the fold is often prominent, running down beside the nose with its concave edge toward the inner canthus.2
A wide fold can hide the nasal sclera and make straight eyes look esotropic, so epicanthus is a common cause of pseudostrabismus.2,3 The examiner can show worried parents that the apparent turn disappears when the skin over the nasal bridge is lifted.2 The fold usually fades as the bridge of the nose develops and has usually resolved by age 4.2,3
Epicanthus also occurs in syndromes, including blepharophimosis syndrome and trisomy 21.3 Persistent folds can be repaired surgically with a Z-plasty or a Y-V-plasty.3
More detail
Epicanthus takes four main forms.1 In the palpebralis type the folds are equally prominent between the upper and lower lids, and this is the most common type in white patients.1 The tarsalis type is most prominent superiorly and is common in Asian patients.1 The inversus type begins in the lower lid and runs up to the medial canthus, and it occurs in blepharophimosis syndrome.1 The superciliaris type arises above the brow and runs down toward the side of the nose.1
Sources (7)
- Kanski's Synopsis of Clinical Ophthalmology, ch. 2
- von Noorden and Campos, Binocular Vision and Ocular Motility, ch. 12
- Color Atlas of Ophthalmology (2009), ch. 2
- Appukuttan, A., Gillanders, J., Josephson, J. D., Helveston, E. M., Ellis, F., & Keltner, J. L. (1978). Duane's retraction syndrome. Journal of pediatric ophthalmology and strabismus, 15(4), 245-249.
- Rutstein, R., Daum, K. (1997). Anomalies of Binocular Vision: Diagnosis & Management, Mosby.
- Parikh, R. S., Desai, A. D., Raj, V., Kaliki, S., Naik, M. N., & Murthy, R. (2012). Duane's retraction syndrome: series of 102 cases. Indian journal of ophthalmology, 60(1), 9-14.
- Hotchkiss, M. G., Miller, N. R., Clark, A. W., & Green, W. R. (1980). Bilateral Duane's retraction syndrome: a pathologic case study. Archives of Ophthalmology, 98(5), 870-874.
Reviewed October 2026