Epicanthal Folds: Causes, Symptoms, and Treatment
Medically reviewed by Harsha Moole, MD, Internal Medicine. Last reviewed: October 23, 2026.
What kind of doctor treats Epicanthal Folds?
A pediatrician (a children's doctor) usually notices epicanthal folds, often at the first well-baby exam. An ophthalmologist (an eye doctor) or a geneticist (a doctor who treats inherited conditions) may help if another condition is suspected. A direct primary care or concierge doctor can be a first stop for an evaluation and can refer you to a specialist when needed.
What are epicanthal folds?
An epicanthal fold is skin of the upper eyelid that covers the inner corner of the eye. Epicanthal folds are usually on both eyes. They may involve the upper eyelid, the lower eyelid, or both.
Symptoms
The fold itself is the main sign. It is a trait that doctors most often find before or during the first well-baby exam. People with Down syndrome often also have an epicanthal fold in the inner corner of the eye.
Causes and who gets it
Epicanthal folds may be normal for people of Asian descent and some non-Asian infants. They also may be seen in young children of any race before the bridge of the nose begins to rise. The tarsalis type is a normal variant of the Asian eyelid.
Epicanthal folds may also be due to certain medical conditions, including:
- Down syndrome.
- Fetal alcohol syndrome.
- Turner syndrome.
- Phenylketonuria (PKU).
- Williams syndrome.
- Noonan syndrome.
How doctors diagnose it
The provider examines the child. The provider also asks about medical history and symptoms. The provider may ask if family members have Down syndrome or another genetic disorder. The provider may also ask about intellectual disability or birth defects in the family. A child who is not Asian and is born with epicanthal folds may be examined for more signs of Down syndrome or other genetic disorders.
To confirm a disorder, tests may include chromosome studies, enzyme assays, metabolic studies, and x-rays.
Treatment
In most cases, no home care is needed. Surgery to fix the fold is only needed now and then. A mild fold in a child is often temporary. The folds disappear as the nose and mid facial bones develop. Doctors usually just watch a child until the face matures, if there are no other eyelid problems. A type called epicanthus inversus rarely goes away with growth and usually needs surgery.
When to see a doctor
Contact your health care provider if you notice epicanthal folds on your child's eyes and the reason for them is unknown. Also contact your provider if your infant has abnormal features of the face. Do the same if you worry about your infant's ability to move their eyes. Contact your provider if you notice abnormal color, swelling, or discharge from your infant's eyes.
How a direct primary care or concierge doctor fits in
A direct primary care doctor charges a flat monthly fee instead of billing insurance, while a concierge doctor usually charges more and often works alongside insurance. Such a doctor can check your child's eyes, review family history, and refer you to an eye doctor or geneticist.
Common questions
Are epicanthal folds normal?
Often, yes. Young children of any race may have them before the bridge of the nose begins to rise.
Do epicanthal folds go away?
Sometimes, in children. A mild fold in a child often fades as the nose and mid facial bones develop. Epicanthus inversus rarely goes away with growth.
Do epicanthal folds mean a child has Down syndrome?
No, not by themselves. Epicanthal folds can also be due to conditions such as Down syndrome. So a child who is not Asian may be checked for other signs.
Do epicanthal folds need treatment?
Usually not. Surgery to fix the fold is only needed now and then.
When should I call a doctor about epicanthal folds?
Call a doctor if you notice the folds on your child's eyes and the reason is unknown. This trait is most often found before or during the first well-baby exam.
Sources
- MedlinePlus - Epicanthal folds
- MedlinePlus - Palpebral slant - eye
- American Academy of Ophthalmology - EyeWiki: Epicanthal Folds
Medical Disclaimer
This content is for general educational and informational purposes only and is not medical advice. It is not a substitute for professional medical advice, diagnosis, or treatment, and reading it does not create a doctor-patient relationship. Always seek the advice of your physician or another qualified health provider with any questions about a medical condition, and never disregard or delay seeking professional advice because of something you read here. If you think you may have a medical emergency, call 911 (or your local emergency number) immediately.
