2020–2021 BCSC Basic and Clinical Science Course™
7 Oculofacial Plastic and Orbital Surgery
Part II: Periocular Soft Tissues
Chapter 10: Classification of Eyelid Disorders
Congenital Anomalies
Epicanthus
Epicanthus is a medial canthal fold that may result from immature midfacial bones or a fold of skin and subcutaneous tissue (see Fig 10-4C). The condition is usually bilateral, and an affected child may appear esotropic owing to decreased scleral exposure nasally (pseudostrabismus). Traditionally, 4 types of epicanthus have been described:
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epicanthus tarsalis, in which the fold is most prominent in the upper eyelid
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epicanthus inversus, in which the fold is most prominent in the lower eyelid
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epicanthus palpebralis, in which the fold involves the upper and lower eyelids equally
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epicanthus supraciliaris, in which the fold extends from the eyebrow region to the lacrimal sac
Epicanthus tarsalis can be a normal variation of the Asian eyelid (Fig 10-7), whereas epicanthus inversus is often associated with BPES.
Most forms of epicanthus become less apparent with normal growth of the facial bones. If no associated eyelid anomalies are present, observation is recommended until the face achieves maturity. Epicanthus inversus, however, rarely resolves with facial growth. Most cases of isolated epicanthus requiring treatment are corrected by soft-tissue revisions such as Z-plasty or Y-V-plasty (Fig 10-8). Epicanthus tarsalis in an Asian patient may be eliminated by a Y-V-plasty with or without formation of an upper eyelid crease.
Excerpted from BCSC 2020-2021 series: Section 10 - Glaucoma. For more information and to purchase the entire series, please visit https://www.aao.org/bcsc.