Epicanthic fold

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Epicanthic fold
Epicanthic KR02.jpg
A Korean girl with the skin fold of the upper eyelid covering the inner angle of the eye
Details
SynonymsEpicanthal 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 presence 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.

Contents

The primary cause of the epicanthic fold is the hypertrophy of the preseptal portion of the orbicularis oculi muscle. [10] [11] [12]

Etymology

Epicanthus means 'above the canthus', with epi-canthus being the Latinized form of the Ancient Greek ἐπί κανθός : 'corner of the eye'.

Classification

This image highlights the epicanthic folds in a person of Mongol descent. Epicanthic Fold.jpg
This image highlights the epicanthic folds in a person of Mongol descent.

Variation in the shape of the epicanthic fold has led to four types being recognised:

Ethnogeographic distribution

High-frequency populations

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, Sámi people and some African people (especially among Khoisan and Nilotic people). Among South Asians, they occur at very high frequencies among the Nepalis, Bhutanese, [14] [ better source needed ] Northeast Indians, [14] Kirati people and certain Adivasi [14] 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. [15]

Lower-frequency populations

Epicanthic folds also occur, at a considerably lower frequency, in other populations: Europeans (e.g., Scandinavians, English, Irish, [16] Hungarians, Russians, Poles, Lithuanians, Latvians, Finns, and Estonians), [17] [18] Jews, South Asians (Bengalis, [14] Sinhalese, [19] among other groups in eastern and southern South Asia), [14] Nilotes, Cushites, and Amazigh people. [20]

Perception and attribution

Swedish ski racer Jens Byggmark with an epicanthic fold over his left eye. Jens Byggmark Schladming 2008.jpg
Swedish ski racer Jens Byggmark with an epicanthic fold over his left eye.

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]

Possible evolutionary function

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, this does not explain its occurrence in various African peoples. 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. [21]

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 pleiotropic genes that control more than one characteristic or function. He also did not offer an explanation for the origin of epicanthic folds. [22]

Other factors

The Khoi, the San and some other African groups have a high frequency of the epicanthic fold. Bosquimanos-Grassland Bushmen Lodge, Botswana 03.jpg
The Khoi, the San and some other African groups have a high frequency of the epicanthic fold.

Age

Many fetuses lose their epicanthic folds after three to six months of gestation. [23] Epicanthic folds may be visible in the development stages of young children of any ethnicity, especially before the nose bridge fully develops. [24]

Medical conditions

Epicanthic fold prevalence can sometimes be found as a sign of congenital abnormality, such as in Zellweger syndrome [25] 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. [26] [27]

Other examples are fetal alcohol syndrome, phenylketonuria, and Turner syndrome. [28]

Epicanthic Folds. (Note that the tarsal plates are exposed Laterally.) Epicanthic KR07.jpg
Epicanthic Folds. (Note that the tarsal plates are exposed Laterally.)

Misclassification of Monolids and Epicanthic Folds

Monolids and epicanthic folds are often used interchangeably, but they refer to different eyelid types. Monolids are characterized by the absence of an upper eyelid crease, with the tarsal plates being obscured. In contrast, epicanthic folds are defined by the presence of excess upper eyelid skin that forms a curve over the inner corners of the eyes, while the tarsal plates remain exposed completely or laterally.

Monolids. (In Monolids, the tarsal plate is barely visible or not noticeable at all.) Epicanthicfold.JPG
Monolids. (In Monolids, the tarsal plate is barely visible or not noticeable at all.)


See also

References

  1. ↑ "Eye fold".
  2. 1 2 Das, Ram Narayan (1997). Sterling Dictionary of Anthropology. Sterling. ISBN   9788173590689.
  3. ↑ "Palpebronasal Fold - Medical Dictionary Search". Stedman's Medical Dictionary . 2006. Retrieved 1 October 2009.
  4. ↑ Wells, John (3 April 2008). Longman Pronunciation Dictionary (3rd ed.). Pearson Longman. ISBN   978-1-4058-8118-0.
  5. ↑ "AllRefer Health – Epicanthal Folds (Plica Palpebronasalis)". AllRefer.com. Archived from the original on 12 January 2010. Retrieved 1 October 2009.
  6. ↑ "Epicanthus | definition of epicanthus by Medical dictionary" . Retrieved 21 July 2020.
  7. ↑ Powell, M. L. (1981) Assessment and management of developmental changes and problems in children, Mosby, Incorporated, p. 38 ISBN   9780801615207
  8. ↑ U. Schilbach, U. and Rott, H-D. (1988) Ocular Hypotelorism, Submucosal Cleft Palate, and Hypospadias: A New Autosomal Dominant Syndrome, American Journal of Medical Genetics 31, pp. 863–870
  9. 1 2 Lang, Berel, ed. (2000). Race and Racism in Theory and Practice. Rowman & Littlefield. p. 10. ISBN   9780847696932.
  10. ↑ Wang, Bulin; Zhang, Shengchang; Chen, Yi; Liu, Zhihong; Yu, Jiangang; Zhou, Huimin; Pan, Er (2024). "A comparative retrospective analysis: Myocutaneous flap versus skin flap in V-Y medial epicanthal fold reconstruction". Frontiers in Surgery. 11. doi: 10.3389/fsurg.2024.1335796 . PMC   10937365 . PMID   38486795.
  11. ↑ Kwon, B.; Nguyen, A. H. (2015). "Reconsideration of the Epicanthus: Evolution of the Eyelid and the Devolutional Concept of Asian Blepharoplasty". Seminars in Plastic Surgery. 29 (3): 171–183. doi:10.1055/s-0035-1556849. PMC   4536067 . PMID   26306084.
  12. ↑ Saonanon, Preamjit; Whipple, Katherine M. (2015). "Update on Asian Eyelid Anatomy and Periocular Aging Change". Textbook of Aging Skin. pp. 1–13. doi:10.1007/978-3-642-27814-3_157-1. ISBN   978-3-642-27814-3.
  13. ↑ Nguyen, M.Q., Hsu, P.W. and Dinh, T.A. (2009) Asian Blepharoplasty, Semin Plast Surg. 2009 Aug; 23(3), pp. 185–197 doi: 10.1055/s-0029-1224798, p. 189
  14. 1 2 3 4 5 Coon, Carleton Stevens; Hunt, Edward E. (21 April 1966). "The Living Races of Man". Cape – via Google Books.
  15. ↑ Lee, Yoonho; Lee, Euitae; Park, Won Jin (2000). "Anchor Epicanthoplasty Combined with OutFold Type Double Eyelidplasty for Asians: Do We Have to Make an Additional Scar to Correct the Asian Epicanthal Fold?". Plastic and Reconstructive Surgery. 105 (5): 1866–70, discussion 1871. doi:10.1097/00006534-200004050-00040. PMID   10809118. Closed Access logo transparent.svg
  16. ↑ "Q&A". The New York Times. 8 October 1985. ISSN   0362-4331 . Retrieved 12 November 2016.
  17. ↑ "epicanthic fold (anatomy)". Encyclopædia Britannica. Retrieved 25 April 2014.
  18. ↑ Montagu, A. (1989). Growing Young (2nd ed.). Granby, Mass: Bergin & Garvey. ISBN   978-0-89789-166-0.
  19. ↑ Angel, J. Lawrence (1963). "The Physical Anthropology of Ceylon. Howard W. Stoudt". American Anthropologist. 65 (3): 694–695. doi: 10.1525/aa.1963.65.3.02a00260 .
  20. ↑ Hassan, M. M. (September 1962). "Mongolism in Sudanese children". Journal of Tropical Pediatrics. 8 (2): 48–50. doi:10.1093/oxfordjournals.tropej.a057626. PMID   13905256.
  21. ↑ Lang, Berel, ed. (2000). Race and Racism in Theory and Practice. Rowman & Littlefield. pp. 10–11. ISBN   9780847696932.
  22. ↑ "ORIGIN OF SHAPE OF ASIAN EYES IS STILL A MYSTERY TO SCIENTISTS". Chicago Tribune. "Dr. Frank Poirier, a physical anthropologist at Ohio State University, says the classical explanation of epicanthic fold depicts it as an adaptation to the tropical and arctic regions where many Asians live. The fold is described as a sun visor protecting the eyes from overexposure to ultraviolet radiation or as a blanket insulating them from the cold. According to Poirier, the problem with this theory is that a substantial portion of the Asian population evolved in areas outside of the tropical and arctic regions. In addition, he says epicanthic fold is not limited to Asians. John F. Kennedy had a variance of the fold and it is found among Europeans, especially the Irish, he said. It's just less prevalent. The fold is also found among infants worldwide. Poirier attributes the fold to pleiotropic genes--single genes that control more than one characteristic or function--but he has no explanation for its origin."
  23. ↑ Park JI (1 January 2000). "Modified Z-Epicanthoplasty in the Asian Eyelid". Archives of Facial Plastic Surgery. 2 (1): 43–47. doi:10.1001/archfaci.2.1.43. ISSN   1521-2491. PMID   10925423.
  24. ↑ "Epicanthal folds". MedlinePlus. U.S National Library of Medicine.
  25. ↑ Kalyanasundaram, S.; et al. (2010). "Peroxisomal Disorder-Unusual Presentation as Failure to Thrive in Early Infancy". Indian Journal of Pediatrics. 77 (10): 1151–1152. doi:10.1007/s12098-010-0199-6. PMID   20872098. S2CID   5736554.
  26. ↑ Hammer, Gary, D.; McPhee, Stephen J. (2010). "Pathophysiology of Selected Genetic Diseases". Pathophysiology of Disease: An Introduction to Clinical Medicine (6 ed.). New York: McGraw-Hill Medical. ISBN   978-0-07-162167-0.{{cite book}}: CS1 maint: multiple names: authors list (link)
  27. ↑ Pham, V. (2010). COMMON OTOLARYNGOLOGICAL CONGENITAL ABNORMALITIES. UTMB, Dept. of Otolaryngology. Archived 6 October 2011 at the Wayback Machine
  28. ↑ Kaneshiro, Neil K.; Zieve, David; Ogilvie, Isla. "Epicanthal folds". MedlinePlus .
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