Epicanthal Fold: What It Is, Why It Forms and When It Matters
epicanthal fold is a fold of upper eyelid skin that covers part of the inner corner of the eye. It is very common in East Asian eyes and in young children, and it is usually a normal feature rather than a medical problem. It does, however, shape how "open" the inner corner looks and how a double eyelid crease runs.
If you've ever wondered why your eyes look further apart than they measure, or why your crease seems to disappear near the nose, this small fold is often the reason.
Where the epicanthal fold sits
At the inner corner of the eye there is a small pink mound of tissue called the caruncle. With an epicanthal fold, a curtain of skin drapes over part or most of it, making the inner corner look rounded and hooded.
Types of epicanthal fold
Doctors describe folds by where they start: from the brow area, the upper lid, or the lower lid. The type most often seen in Asian eyes starts on the upper lid and fades towards the inner corner.
What an epicanthal fold can affect
Inner corner appearance: the eyes can look further apart than they really are.
Crease shape: the fold often makes the double eyelid crease tuck in near the nose (an "inside" or tapered crease).
Pseudo-squint in children: the fold hides the white of the eye on the nose side, so straight eyes can look crossed.
Associated conditions: occasionally it appears alongside congenital ptosis or certain genetic syndromes, which a doctor will assess separately.
Does it need to be changed?
Most people never need to do anything about it. For those who would like a more open inner corner, or a crease that runs parallel all the way to the inner corner, epicanthoplasty can be considered, sometimes together with double eyelid surgery.
There are trade-offs: scarring at the inner corner is possible, and over-correction can make the corner look sharp or unnatural. An assessment by an oculoplastic ophthalmologist helps decide whether it suits your eyes. Learn more on our epicanthoplasty page and in our guide to eye enlargement surgery.
When to see an eye doctor
a child's eyes look crossed, or they tilt their head to see
a droopy upper lid that doesn't open fully
you are planning double eyelid surgery or epicanthoplasty and want to know which eye shape suits you
Book a consultation with Assoc. Prof. Dr. Preamjit Saonanon in Thong Lo, Bangkok
Opening hours: Thursday 16:00–20:00 and Saturday 09:00–20:00
This article is general information and does not replace a medical examination. Results vary from person to person.
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