EYELIDS Epicanthic folds Epicanthie folds are bilateral vertical folds of skin that extend from the upper or lower lids towards the medial canthi. They may give rise toa pseudo-esatropiaa 4, Palpebralis. ‘he folds are symmetrically distributed between the upper and lower lids (Fig, 3.1/a) this is the most common type in Caucasians. b, Tarsalis. The folds originate in the medial aspects of the upper lids and extend medially belore dissipating (Fig. 3.1 bic this is the most common type in Orientals ¢. Inversus is associated with the bleplarophimosis syndrome. The folds start in the lower lids and extend upwards to the medial canthal areas (Pig. 3.1ct. d, Superciliaris. ‘The folds arise above the brow and extend downwards to the lateral aspeet of the nose, 2. Treatment of small olds is by YoV' plasty, whilst large folds require a Mustarde Z-plasty. Telecanthus Telgcanthus is an uncommon condition that may occur in isolation or in association with blepharophimasis syndrome (sce Fig. 3.3), 1, Signs. Increased distance between the medial canthi as a result of abnormally long medial canthal tendons (Fig. 3.2). should not be confused with hrypertelorism in which there is wide separation of the orbits 2. Treatment involves shortening and retivation of the medial eanthal tendons to the anterior lacrimal ¢rest or insertion of a transnasal suture 3. Associated systemic syndromes iinchide Waardenburg. Mobius. Treacher Collins, Rubinstein~Taybi and Turner. Blepharop! josis syndrome 1. Inheritance. The blepharophtimosis syndrome (BPS) is a rare, AD disorder. BPS1 (with premature ovarian failure} and BPS2 (without premature ovarian by mutations in FON1.2 gene on chromosome 3. 2. Signs (Fig. 3.3) © Moderate to severe symmetrical ptosis with poor levator function Short horizontal palpebral aperture. Telecanthus and epicanthus inversus, Lateral ectropion of lower lids Poorly developed nasal bridge and hypoplasia of the superior orbital rims, Fig. 3.1 Epicanthic folds, (a) Palpebralis;(b) tarsals;(c) inversus Fig. 3.2 Telecanthus 3. Treatment initially involves correction of epicanthus fand telecanthus followed a few months later by bilateral frontalis suspension, [i Is also important to treat ‘amblyopia which is present in about 50) Epiblepharon spiblephardn i very Gomtinod tn Orleintals and should not be confused with the mach less comtnon congenital entropion,