Monolid Eyes

What are monolid eyes?

Monolid eyes are also called epicanthal folds or epicanthic folds. An epicanthal fold describes an eyelid shape. If you have epicanthal folds, the skin of your upper eyelid is smooth from the inner corner of your eye to the part of your eyebrow nearest to your nose. It covers the innermost edge of your eyes.

Monolids can make your eyes look smaller because you don’t have creases or folds separating your eyelids into two sections. Monolids decrease the opening between your upper eyelids and lower eyelids.

Epicanthal folds are very common, especially in people of Asian descent. Monolids are also a common characteristic found in some genetic conditions, such as Down syndrome.

What’s the difference between monolids and double lids?

If you have double lids (double eyelids), you have arc-shaped creases between your eyelashes and eyebrows. Monolids don’t have these visible creases between the eyelashes and eyebrows.

Monolids aren’t the same thing as ptosis. Ptosis is an abnormality that causes drooping of your eyelid. It can impair your vision and is often cosmetically unappealing because it generally affects only one eye. Ptosis may need to be surgically corrected.

What are the most common causes of monolid eyes?

Monolids are generally caused by genetics. They are found in about 50% of people of Asian descent. Epicanthal folds are also seen in non-Asian babies and young children before the bridge of their noses develops.

People born with fetal alcohol syndrome may also have epicanthal folds. Fetal alcohol syndrome can occur when a birthing parent drinks during pregnancy. It can cause physical, behavioral and learning disabilities.

Epicanthal folds are also a facial characteristic commonly seen in many genetic conditions. These genetic conditions include:

• Down syndrome: This condition causes unique physical traits and developmental delays. People with Down syndrome are born with an extra chromosome.
• Turner syndrome: This condition affects only people assigned female at birth. It causes short stature and developmental delays. People with Turner syndrome are born with one of their X chromosomes missing.
• Phenylketonuria (PKU): Phenylketonuria causes phenylalanine to collect in your blood. Phenylalanine is an amino acid. If phenylalanine builds up, it can cause brain damage.
• Williams syndrome: This condition causes distinct facial features, development delays and learning problems. People with Williams syndrome were born with a piece of chromosome 7 missing.
• Noonan syndrome: Noonan syndrome causes unique facial characteristics and heart problems. Changes (mutations) in certain genes cause Noonan syndrome.
• Triple X syndrome: Triple X syndrome, or trisomy X syndrome, only affects people assigned female at birth. People with Triple X syndrome have an extra X chromosome.
• Zellweger syndrome: Zellweger syndrome causes severe issues with the nervous system and metabolism. A genetic mutation in any of the PEX genes causes Zellweger syndrome.
• Rubinstein-Taybi syndrome: Rubinstein-Taybi syndrome causes unique characteristics including large thumbs and toes. It also causes short stature and intellectual disabilities. A genetic mutation in the CREBBP gene causes Rubinstein-Taybi syndrome.
• Blepharophimosis syndrome: Blepharophimosis syndrome causes several problems with eyelid development. This includes narrow eye openings and droopy eyelids. A genetic mutation in the FOXL2 gene causes Blepharophimosis syndrome.

How can epicanthal folds be treated?

Epicanthal folds are normal, harmless and don’t require treatment. But if you want to change the appearance of your eyelids, there are a few options:

• Makeup: Videos online can teach you how to use makeup to add natural-looking creases to your monolids. And makeup artists can show you tips and tricks to make your eyes appear bigger. Eyeshadows in bright colors can make your eyes stand out.
• Adhesives: You can use special glue or tape to create artificial, temporary creases in your eyelids. This can make it look like you have double eyelids without having to do anything too invasive. Talk to your healthcare provider to be sure the adhesive is safe before using it.
• Plastic surgery: If you’re looking to make a permanent change to your eyelids, monolid surgery may be an option. Surgery to create double eyelids isn’t available everywhere. But it’s a common procedure in Asian countries.

What surgical options are available for the treatment of monolids?

Surgery isn’t necessary, or generally recommended, but plastic surgery can change the appearance of your eyelids:

• Blepharoplasty: Blepharoplasty is a type of eyelid surgery. It can permanently change monolid eyes to double eyelids. Your surgeon will create the look of creases in your eyelids. They may remove excess skin or fat to make sure the creases stay in place.
• Epicanthoplasty: Epicanthoplasty surgery can lengthen the inner corners of your eyes. This can make them appear bigger. Your surgeon will extend the inner corners of your eyes toward your nose.

When should I call my child’s healthcare provider?

If your baby is of Asian descent, epicanthal folds are a normal, common trait. If your baby isn’t Asian, their healthcare provider will see the trait before or during their first well-baby checkup.

If you notice epicanthal folds after your baby’s first well-baby checkup, call their healthcare provider. They will examine your baby for signs of Down syndrome and other genetic conditions. They may ask you about your family’s medical history, especially genetic conditions, intellectual disabilities or birth defects.

A note from Cleveland Clinic

Monolids or epicanthal folds are common and normal, especially among people of Asian descent. Your monolids are a part of who you are and you may choose to embrace that. If you want to change the look of your eyelids, make sure you’re doing it for the right reasons. If your newborn isn’t Asian and they are born with epicanthal folds, be sure to speak with their healthcare provider. It may be normal, but they will evaluate your baby for genetic conditions that may need to be addressed.