An epicanthic fold or epicanthus is a skin fold of the upper eyelid that covers the inner corner of the eye. However, variation occurs in the nature of this feature and the possession of 'partial epicanthic folds' or 'slight epicanthic folds' is noted in the relevant literature. Various factors influence whether epicanthic folds form, including ancestry, age, and certain medical conditions.
Etymology
Epicanthus means 'above the canthus' with canthus being the Latinized form of the Ancient Greek : kanthós, 'corner of the eye'.
Classification
Variation in the shape of the epicanthic fold has led to four types being recognised:
Epicanthus supraciliaris runs from the brow, curving downwards towards the lachrymal sac.
Epicanthus palpebralis begins above the upper tarsus and extends to the inferior orbital rim.
Epicanthus tarsalis originates at the upper eyelid crease and merges into the skin near the medial canthus. This is the type most often found in East Asians.
Epicanthus inversus runs from the lower eyelid skin over the medial canthus and extends to the upper lid.
Ethnogeographic distribution
High-frequency populations
The highest frequency of occurrence of epicanthic folds is found in specific ethnicities: East Asians, Southeast Asians, Central Asians, North Asians, Polynesians, Micronesians, Native Americans, the Khoisan, and the Malagasy. Among South Asians, they occur at very high frequencies among the Bhutanese, Northeast Indians, Kirati, and certain Adivasi tribes of eastern India. In some of these populations the trait is almost universal, specifically in East Asians and Southeast Asians, where a majority, up to 90% in some estimations, of adults have this feature.
Lower-frequency populations
Epicanthic folds also occur, at a considerably lower frequency, in other populations: Europeans, South Asians, Nilotes, Cushitics and Amazigh people. The degree of development of the fold between individuals varies greatly, attribution of its presence or absence is often subjective, and its frequency varies clinally across Eurasia. Its use, therefore, as a phenotypic marker to define biological populations is debatable.
Possible evolutionary function
The epicanthic fold is often associated with greater levels of fat deposition around the eyeball, a feature most accentuated in native North Siberian, Aleut and Inuit populations. The adipose tissue is thought to provide greater insulation for the eye and sinuses from the effects of cold, especially from freezing winds, and to represent an adaptation to cold climates. It has also been postulated that the fold itself may provide a level of protection from snow blindness. Though its appearance in peoples of Southeast Asia can be linked to possible descent from cold-adapted ancestors, its occurrence in various African peoples precludes a cold-adaptive explanation for it appearing in the latter groups. The epicanthic fold found in some African people has been tentatively linked to protection for the eye from the high levels of ultraviolet light found in desert and semi-desert areas.
Other factors
Age
Many fetuses lose their epicanthic folds after three to six months of gestation. Epicanthic folds may be visible in the development stages of young children of any ethnicity, especially before the nose bridge fully develops.
The epicanthic fold is sometimes found as a congenital abnormality. Medical conditions that cause the nasal bridge not to mature and project are associated with epicanthic folds. About 60% of individuals with Down syndrome have prominent epicanthic folds. In 1862, John Langdon Down classified what is now called Down syndrome. He used the term mongoloid for the condition. This was derived from then-prevailing ethnic theory and from his perception that children with Down syndrome shared physical facial similarities with those of Blumenbach's Mongolian race. While the term "mongoloid" continued to be used until the early 1970s, it is now considered pejorative and inaccurate and is no longer in common use about medical conditions. In Zellweger syndrome, epicanthic folds are prominent. Other examples are fetal alcohol syndrome, phenylketonuria, and Turner syndrome.
