Telecanthus

What is telecanthus?

Telecanthus is an increased distance between the inner corners of your eyelids (medial canthi). It’s usually congenital, meaning it’s present when you’re born. Telecanthus is typically caused by genetic disorders.

Traumas (like injuries to your face) or having a tumor surgically removed can cause telecanthus, too.

Another name for telecanthus is dystopia canthorum.

How can telecanthus affect my child?

If you’re a parent of a child with telecanthus, you’re likely concerned about their physical and emotional well-being. The good news? Telecanthus on its own isn’t a painful condition and doesn’t usually cause problems with eyesight. But telecanthus that occurs with other eye abnormalities can lead to vision problems.

Your child may also feel uncomfortable or self-conscious about having telecanthus. They may feel that their eyes don’t look “normal.” If it affects your child’s self-esteem, a healthcare provider can tell you more about surgically correcting telecanthus. Talking to a mental health professional might also be helpful.

Who is affected by telecanthus?

Telecanthus is usually a symptom of a genetic disorder that’s present when your baby is born. The most common genetic disorders that cause telecanthus include:

• Cri du chat syndrome (may cause problems with growth and development, including a high-pitched, cat-like cry).
• Down syndrome.
• Dubowitz syndrome.
• Ehlers-Danlos syndrome.
• Fetal alcohol syndrome.
• Klinefelter syndrome.
• Noonan syndrome.
• SHORT syndrome.
• Turner syndrome.
• Waardenburg syndrome.

Some factors increase the risk of your child being born with a genetic disorder, including:

• Recreational drug use.
• Exposure to harmful chemicals or radiation while you’re pregnant.
• Having a biological family history of genetic disorders.

Can adults get telecanthus?

Although rare, you can develop telecanthus even if you aren’t born with the condition. Sometimes, traumatic injuries or tumors affect the shape of your face, which can move the corners of one or both eyes closer together.

How common is telecanthus?

Telecanthus on its own is very rare. It usually occurs along with other genetic syndromes.

What are the symptoms of telecanthus?

Telecanthus itself doesn’t usually cause any eye pain or vision problems. But as part of other syndromes that affect how your eyes develop, it can cause:

• Low vision.
• Myopia (nearsightedness).
• Hyperopia (farsightedness).

What causes telecanthus?

Some people are born with telecanthus (congenital). If you have congenital telecanthus, the tendons that position your eyelids (medial canthal tendons) are too long or aren’t in the right place. Instead of pulling the inner corners of your eyelids closer together, they’re spread farther apart.

Others develop the condition later in life following certain injuries or illnesses, such as:

• Naso-orbital ethmoid (NOE) fractures.
• Squamous cell carcinomas.
• Basal cell carcinomas.

What causes traumatic telecanthus?

Facial injuries cause traumatic telecanthus. Traumas like falls or car accidents can cause naso-orbital ethmoid (NOE) fractures. NOE fractures can affect your nose, nasal bones, eye sockets, forehead and the front part of your skull. NOE fractures can also damage your medial canthal tendons and cause telecanthus.

Tumors — usually squamous or basal cell carcinomas — can also cause traumatic telecanthus. If they form in the inner corners of your eyelids surgery to remove them can damage your medial canthal tendons and cause traumatic telecanthus.

What is pseudotelecanthus?

Traumatic injuries can lead to a lot of swelling, scarring and fluid build-up between your eyes and around the top of your nose and forehead. These complications might make it look like the inner corners of your eyelids are too far apart. An eye care specialist might call this secondary telecanthus, or pseudotelecanthus, to differentiate it from the original injury.

How is telecanthus diagnosed?

A healthcare provider might notice that your baby’s eyes are too far apart soon after birth. They’ll use a special ruler to measure the distance between the inner corners of your baby’s eyelids (inner canthal distance).

Your child might also need imaging tests, including:

• CT scan.
• Genetic testing to identify genetic disorders.
• X-ray.

A healthcare provider will also examine other features of your baby’s face and skull. As telecanthus doesn’t usually happen on its own, it’s likely your baby will have other symptoms, too. Some genetic disorders that can cause telecanthus can also cause problems with their heart, kidneys, bones and nervous system.

What kind of healthcare provider treats telecanthus?

An oculoplastic surgeon usually treats telecanthus, including issues that affect your:

• Eye sockets.
• Tear ducts.
• Facial bones.

Sometimes, otolaryngologists (ear, nose and throat doctors) specializing in head and neck surgery also treat telecanthus.

Because telecanthus is usually caused by other health conditions, you or your child’s care team may also include other types of healthcare providers.

How is telecanthus treated?

Surgery is the main treatment for telecanthus. Some people choose surgery for cosmetic reasons. Surgeries may include:

• Tendon shortening and fixation: A surgeon cuts your medial canthal tendons to the correct length. They secure the shortened tendons to a bone that sits between the side of your nose and your eye socket. Tendon shortening and fixation are usually for congenital telecanthus.
• Transnasal wiring:Transnasal wiring is usually for traumatic telecanthus. A surgeon detaches your medial canthal tendon from your affected eye and repositions it. Your tendon is secured to your skull using very thin wire. The wire runs through tiny holes drilled into the inside of your eye socket and nose bones.

Mild telecanthus that doesn’t affect your vision or self-esteem might not need treatment.

How can I prevent telecanthus?

There’s no way to prevent telecanthus. You can talk to a healthcare provider about genetic counseling if you’re concerned about passing genetic disorders to your children.

What’s the outlook for someone with telecanthus?

Telecanthus doesn’t worsen with age and typically doesn’t require treatment. Telecanthus surgery is usually effective, but it’s possible that your medial canthi may move closer together again after surgery. Some people need a second surgery.

Telecanthus from a genetic disorder can lead to more serious long-term effects, such as:

• Developmental delays.
• Learning disabilities.
• Problems with your heart, lungs, gastrointestinal tract and other organs.

What questions should I ask my healthcare provider?

• Does my child have other eye problems besides telecanthus?
• Does telecanthus need treatment?
• How can I help my child deal with the emotional and psychological challenges of having telecanthus?
• How soon can my child have telecanthus corrective surgery?
• What’s causing telecanthus?

What’s the difference between telecanthus and hypertelorism?

If you have telecanthus, only the inner corners of your eyelids are too far apart. The distance between the outer corners of your eyelids (lateral canthi) and pupils won’t be affected. Your eyes might not appear too far apart, but your inner eyelids might be noticeably closer to your iris (the colored part of your eye).

People with hypertelorism have an increased distance between both the inner and outer corners of their eyelids, as well as their pupils. Hypertelorism might make it more noticeable that your eyes are too far apart. Both conditions can be the result of genetic disorders. Sometimes, telecanthus is called pseudohypertelorism.

What’s the difference between telecanthus and epicanthus?

Epicanthus happens when the skin on the inner part of your upper eyelid folds down over the inner corner of your eyelid. An eye care specialist might call it an epicanthal fold, or monolid eyes. Epicanthus and telecanthus often occur together.

What’s the difference between telecanthus and blepharophimosis-ptosis-epicanthus inversus syndrome (BPES)?

BPES is a condition that affects how the skin around your eye develops. It often includes telecanthus. BPES might also cause:

• Blepharophimosis: Very narrow and underdeveloped eyelids that don’t open all the way.
• Epicanthus inversus: The skin on the inner part of your lower eyelid folds up over the inner corner of your eyelid.
• Ptosis: Ptosis happens when your upper eyelid droops or sags.

A note from Cleveland Clinic

Telecanthus is rare, but it can be challenging for you or your child. It’s usually caused by a genetic disorder that can create other complications in your child’s eyes or throughout their body.

Surgery is the main treatment for telecanthus. Talk to a healthcare provider or mental health provider if you or your child have self-esteem issues caused by telecanthus.