Epicanthic fold | |
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Details | |
Synonyms | Epicanthal fold, epicanthus, eye fold, [1] Mongoloid fold, [2] palpebronasal fold [3] |
Pronunciation | /ˌɛpɪˌkænθɪkˈfoʊld/ [4] |
Identifiers | |
Latin | plica palpebronasalis [5] |
TA98 | A15.2.07.028 |
TA2 | 211 |
FMA | 59370 |
Anatomical terminology |
An epicanthic fold or epicanthus [6] is a skin fold of the upper eyelid that covers the inner corner (medial canthus) of the eye. [2] 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. [7] [8] [9] Various factors influence whether epicanthic folds form, including ancestry, age, and certain medical conditions.
Epicanthus means 'above the canthus', with epi-canthus being the Latinized form of the Ancient Greek ἐπί κανθός : 'corner of the eye'.
Variation in the shape of the epicanthic fold has led to four types being recognised:
The highest frequency of occurrence of epicanthic folds is found in specific populations or ethnicities: East Asians, Southeast Asians, Central Asians, North Asians, Polynesians, Micronesians, Indigenous peoples of the Americas, and some African people (especially among Khoisan and Nilotic people). Among South Asians, they occur at very high frequencies among the Nepalis, Bhutanese, [11] [ better source needed ] Northeast Indians, [11] Kirati people and certain Adivasi [11] tribes of Eastern and Southern India. It is also commonly found in Northern India, especially in Kashmir. The Hazara people in Afghanistan and Pakistan commonly have this trait. Some people in Eastern/Northern Pakistan have this trait.
In some of these populations, the trait is almost universal. This is especially true in East Asians and Southeast Asians, where a majority, up to 90% in some estimations, of adults have this feature. [12]
Epicanthic folds also occur, at a considerably lower frequency, in other populations: Europeans (e.g., Scandinavians, English, Irish, [13] Hungarians, Russians, Poles, Lithuanians, Latvians, Finns, Estonians and Samis), [14] [15] Jews, South Asians (Bengalis, [11] Sinhalese, [16] among other groups in eastern and southern South Asia), [11] Nilotes, Cushites, and Amazigh people. [17]
The degree of development of the fold between individuals varies greatly, and attribution of its presence or absence is often subjective, being to a degree relative to the occurrence of the trait within the community of the specific observer. Also, its frequency varies but can be found in peoples all over the world. Its use, therefore, as a phenotypic marker to define biological populations is debatable. [9]
The epicanthic fold is often associated with greater levels of fat deposition around the eyeball. 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 is not open to this explanation. The epicanthic fold found in many 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. [18]
The exact evolutionary function and origin of epicanthic folds remains unknown. Scientific explanations include either random variation and selection (presumably sexual selection), or possible adaption to desert environment and/or high levels of ultraviolet light found in high-altitude environments, such as the Himalayas.
Dr. Frank Poirier, a physical anthropologist at Ohio State University, said that the epicanthic fold among Asian people is often explained as part of an adaptation to severe cold or tropical environments, however he suggests that neither of these explanations are sufficient to explain its presence in East and Southeast Asia, and notes that the fold can also be observed in Irish and African people. He attributes the epicanthic fold to pleiotrophic genes that control for more than one characteristic or function. He also did not offer an explanation for the origin of epicanthic folds. [19]
Many fetuses lose their epicanthic folds after three to six months of gestation. [20] Epicanthic folds may be visible in the development stages of young children of any ethnicity, especially before the nose bridge fully develops. [21]
Epicanthic fold prevalence can sometimes be found as a sign of congenital abnormality, such as in Zellweger syndrome [22] and Noonan syndrome. Medical conditions that cause the nasal bridge not to develop and project are also associated with epicanthic fold. About 60% of individuals with Down syndrome (also known as trisomy 21) have prominent epicanthic folds. [23] [24] In 1862, John Langdon Down classified what is now called Down syndrome.
Other examples are fetal alcohol syndrome, phenylketonuria, and Turner syndrome. [25]
Human physical appearance is the outward phenotype or look of human beings.
The nictitating membrane is a transparent or translucent third eyelid present in some animals that can be drawn across the eye from the medial canthus to protect and moisten it while maintaining vision. All Anura, some reptiles, birds, and sharks, and some mammals have full nictitating membranes; in many other mammals, a small, vestigial portion of the nictitating membrane remains in the corner of the eye. It is often informally called a third eyelid or haw; the scientific terms for it are the plica semilunaris, membrana nictitans, or palpebra tertia.
Eye surgery, also known as ophthalmic surgery or ocular surgery, is surgery performed on the eye or its adnexa. Eye surgery is part of ophthalmology and is performed by an ophthalmologist or eye surgeon. The eye is a fragile organ, and requires due care before, during, and after a surgical procedure to minimize or prevent further damage. An eye surgeon is responsible for selecting the appropriate surgical procedure for the patient, and for taking the necessary safety precautions. Mentions of eye surgery can be found in several ancient texts dating back as early as 1800 BC, with cataract treatment starting in the fifth century BC. It continues to be a widely practiced class of surgery, with various techniques having been developed for treating eye problems.
An eyelid is a thin fold of skin that covers and protects an eye. The levator palpebrae superioris muscle retracts the eyelid, exposing the cornea to the outside, giving vision. This can be either voluntarily or involuntarily. "Palpebral" means relating to the eyelids. Its key function is to regularly spread the tears and other secretions on the eye surface to keep it moist, since the cornea must be continuously moist. They keep the eyes from drying out when asleep. Moreover, the blink reflex protects the eye from foreign bodies. A set of specialized hairs known as lashes grow from the upper and lower eyelid margins to further protect the eye from dust and debris.
The nasolacrimal duct carries tears from the lacrimal sac of the eye into the nasal cavity. The duct begins in the eye socket between the maxillary and lacrimal bones, from where it passes downwards and backwards. The opening of the nasolacrimal duct into the inferior nasal meatus of the nasal cavity is partially covered by a mucosal fold.
The human eye is a sensory organ in the visual system that reacts to visible light allowing eyesight. Other functions include maintaining the circadian rhythm, and keeping balance.
East Asian blepharoplasty, more commonly known as double eyelid surgery, is a cosmetic procedure that reshapes the skin around the eye to create a crease in an upper eyelid that naturally lacks one. Although the majority of East Asian women naturally haven upper eyelid creases, it is estimated that 17-30% of Chinese and Japanese women lack this feature. This surgery may be performed on individuals of East Asian descent, including those from Chinese, Japanese, and Korean backgrounds. The primary goal is to enhance the eyelid's appearance, making the eyes appear larger and, according to some cultural aesthetics, more attractive due to a 'wide eyed' and expressive appearance.
The canthus is either corner of the eye where the upper and lower eyelids meet. More specifically, the inner and outer canthi are, respectively, the medial and lateral ends/angles of the palpebral fissure.
Blepharoplasty is the plastic surgery operation for correcting defects, deformities, and disfigurations of the eyelids; and for aesthetically modifying the eye region of the face. With the excision and the removal, or the repositioning of excess tissues, such as skin and adipocyte fat, and the reinforcement of the corresponding muscle and tendon tissues, the blepharoplasty procedure resolves functional and cosmetic problems of the periorbita, which is the area from the eyebrow to the upper portion of the cheek. The procedure is more common among women, who accounted for approximately 85% of blepharoplasty procedures in 2014 in the US and 88% of such procedures in the UK.
Saethre–Chotzen syndrome (SCS), also known as acrocephalosyndactyly type III, is a rare congenital disorder associated with craniosynostosis. This affects the shape of the head and face, resulting in a cone-shaped head and an asymmetrical face. Individuals with SCS also have droopy eyelids (ptosis), widely spaced eyes (hypertelorism), and minor abnormalities of the hands and feet (syndactyly). Individuals with more severe cases of SCS may have mild to moderate intellectual or learning disabilities. Depending on the level of severity, some individuals with SCS may require some form of medical or surgical intervention. Most individuals with SCS live fairly normal lives, regardless of whether medical treatment is needed or not.
The orbicularis oculi is a muscle in the face that closes the eyelids. It arises from the nasal part of the frontal bone, from the frontal process of the maxilla in front of the lacrimal groove, and from the anterior surface and borders of a short fibrous band, the medial palpebral ligament.
Epicanthoplasty is a rare eye surgery to modify the epicanthal folds. It can be a challenging procedure because the epicanthal folds overlay the lacrimal canaliculi . Although an epicanthic fold can also be associated with a less prominent upper eyelid crease, the two features are distinct; a person may have both epicanthal folds and an upper eyelid crease, one and not the other, or neither. Single eyelids are reshaped using East Asian blepharoplasty.
The lacrimal lake is the pool of tears in the lower conjunctival cul-de-sac, which drains into the opening of the tear drainage system. The volume of the lacrimal lake has been estimated to be between 7 and 10 μL.
The plica semilunaris is a small fold of bulbar conjunctiva on the medial canthus of the eye. It functions during movement of the eye, to help maintain tear drainage via the lacrimal lake, and to permit greater rotation of the globe, for without the plica the conjunctiva would attach directly to the eyeball, restricting movement. It is the vestigial remnant of the nictitating membrane which is drawn across the eye for protection, and is present in other animals such as birds, reptiles, and fish, but is rare in mammals, mainly found in monotremes and marsupials. Its associated muscles are also vestigial. It is loose, thus eye movements are not restricted by it. Only one species of primate, the Calabar angwantibo, is known to have a functioning nictitating membrane.
Oculoplastics, or oculoplastic surgery, includes a wide variety of surgical procedures that deal with the orbit, eyelids, tear ducts, and the face. It also deals with the reconstruction of the eye and associated structures.
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Mongoloid is an obsolete racial grouping of various peoples indigenous to large parts of Asia, the Americas, and some regions in Europe and Oceania. The term is derived from a now-disproven theory of biological race. In the past, other terms such as "Mongolian race", "yellow", "Asiatic" and "Oriental" have been used as synonyms.
Flammer syndrome is a described clinical entity comprising a complex of clinical features caused mainly by dysregulation of the blood supply. It was previously known as vascular dysregulation. It can manifest in many symptoms, such as cold hands and feet, and is often associated with low blood pressure. In certain cases it is associated with or predisposes to the development of diseases such as a normal tension glaucoma. Flammer syndrome is named after the Swiss ophthalmologist Josef Flammer.
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