Telecanthus: Causes, Symptoms, Diagnosis, and Treatment

Medically reviewed by Dr. Baraa Alnahhal, MD · Last reviewed: October 2026

Quick Answer: What is telecanthus?

Telecanthus, also called dystopia canthorum, is a wider-than-usual distance between the inner corners of the eyelids. It is usually present at birth and commonly linked with genetic disorders, though facial injuries or tumor surgery can cause it later. By itself it usually does not hurt or affect eyesight, but a provider may look for signs of an associated condition. [1]

What the research says

• Surgery can meaningfully reduce the inner eyelid distance in people with BPES, a syndrome that includes telecanthus. In a review of 125 consecutive patients with blepharophimosis-ptosis-epicanthus inversus syndrome who had staged surgery, the mean inner intercanthal distance decreased from 38.0 mm to 30.9 mm (a mean difference of 7.1 mm; P < 0.01), and the authors reported effective functional and cosmetic results (Song et al., Ann Plast Surg, 2015). [3]

• Telecanthus after an old, unrepaired facial fracture can still be corrected. In 13 patients with telecanthus at least six months after naso-orbito-ethmoid fractures, a modified transnasal canthopexy restored the normal position of the inner eyelid corners, with good functional and esthetic results measured by intercanthal distances over an average 12 months of follow-up. Transnasal wiring remains the standard approach but is technically difficult, so treatment belongs with an experienced specialist (Elbarbary & Ali, J Craniomaxillofac Surg, 2014). [4]

What causes telecanthus?

Telecanthus can be congenital or acquired. Congenital telecanthus is present at birth and is typically associated with a genetic disorder. Acquired telecanthus can follow a facial injury, a tumor near the inner corner of an eyelid, or surgery in that area. [1]

In congenital telecanthus, the medial canthal tendons may be too long or positioned differently than usual. These tendons help position the eyelids. If they do not pull the inner corners close enough together, the inner eyelids appear farther apart. [1]

Cause or context	How it may relate to telecanthus
Genetic disorder	Telecanthus may be one feature of a broader genetic syndrome.
Facial trauma	An injury can damage the tendons that support the inner eyelid corners.
Naso-orbital ethmoid fracture	A fracture involving the nose, eye sockets, forehead or front of the skull can affect the medial canthal tendons.
Tumor near the inner eyelid	Squamous cell carcinoma or basal cell carcinoma in this area may affect the tendons.
Tumor-removal surgery	Surgery near the inner eyelid can change the tendon’s position and lead to traumatic telecanthus.
Post-traumatic swelling or scarring	Swelling, scarring and fluid buildup can make the inner eyelids look farther apart.

What genetic disorders are associated with telecanthus?

Telecanthus commonly occurs with genetic disorders that are present at birth. Associated conditions listed in clinical guidance include cri du chat syndrome, Down syndrome, Dubowitz syndrome, Ehlers-Danlos syndrome, fetal alcohol syndrome, Klinefelter syndrome, Noonan syndrome, SHORT syndrome, Turner syndrome and Waardenburg syndrome. [1]

Telecanthus is a physical finding, not a diagnosis of any one genetic disorder. If a child has telecanthus, a healthcare provider may examine other features and decide whether genetic testing or additional evaluation is appropriate.

Some factors can increase the risk of a child being born with a genetic disorder. These include recreational drug use, exposure to harmful chemicals or radiation during pregnancy, and a biological family history of genetic disorders. These factors do not establish the cause of telecanthus in an individual child.

Can adults develop telecanthus?

Yes, although it is rare. Adults can develop telecanthus after a traumatic injury or an illness that changes the shape of the face. A facial injury or a tumor near the inner eyelid can move one or both inner eyelid corners farther apart. [1]

How common is telecanthus?

Telecanthus on its own is very rare. It more often appears along with another genetic syndrome or health condition. [1]

What are the symptoms of telecanthus?

Telecanthus itself usually does not cause eye pain or vision problems. Some people may notice that the inner corners of the eyelids appear farther apart. The appearance can be present on one or both sides, particularly when it follows a facial injury. [1]

When telecanthus occurs with other conditions that affect eye development, a person may have low vision, myopia or hyperopia. These vision problems are related to associated eye or developmental differences rather than to the eyelid spacing alone.

A child may also feel self-conscious or uncomfortable about the appearance of their eyes. If appearance-related concerns affect self-esteem, a healthcare provider can discuss possible corrective surgery, and a mental-health professional may provide additional support.

What is traumatic telecanthus?

Traumatic telecanthus develops after a facial injury or after surgery near the inner corner of an eye. Falls and car accidents can cause naso-orbital ethmoid fractures. These injuries may involve the nose, nasal bones, eye sockets, forehead and the front part of the skull. They can also damage the medial canthal tendons and cause the inner eyelid corners to separate. [1]

Tumors near the inner eyelid can also cause traumatic telecanthus. Tumor-removal surgery may damage or reposition the medial canthal tendons. [1]

What is pseudotelecanthus?

Pseudotelecanthus, also called secondary telecanthus, is an appearance that resembles telecanthus after an injury. Swelling, scarring and fluid buildup between the eyes and around the upper nose and forehead can make the inner eyelids look farther apart. [1]

An eye-care specialist may use the term pseudotelecanthus to distinguish this appearance from the original injury or from congenital telecanthus.

How is telecanthus diagnosed?

A healthcare provider may notice telecanthus soon after a baby is born. The provider can use a special ruler to measure the distance between the inner corners of the eyelids, called the inner canthal distance. [1]

The evaluation may include an examination of the face, skull, eyes and other physical features. Because telecanthus often occurs with other conditions, the care team may look for signs involving the heart, kidneys, bones, nervous system or other organs.

Possible tests include a CT scan, X-ray and genetic testing. The exact evaluation depends on the person’s age, history, physical findings, and whether the telecanthus is congenital or follows an injury or illness. [1]

Evaluation step	What it may do
Physical examination	Looks at the eyes, eyelids, face and skull.
Measurement	Records the distance between the inner eyelid corners.
CT scan or X-ray	Helps evaluate facial bones or injuries when indicated.
Genetic testing	May help identify an associated genetic disorder.
Broader health assessment	Looks for possible effects involving the heart, kidneys, bones, nervous system or other organs.

Which healthcare provider treats telecanthus?

An oculoplastic surgeon usually treats telecanthus. Oculoplastic surgeons care for conditions involving the eye sockets, tear ducts, eyelids and facial bones. [1]

An otolaryngologist, or ear, nose and throat specialist, who focuses on head and neck surgery may also treat telecanthus. Because telecanthus is often associated with other health conditions, a person’s care team may include additional specialists. [1]

How is telecanthus treated?

Surgery is the main treatment for telecanthus when treatment is needed. Some people consider surgery for cosmetic reasons, while others may need evaluation because of associated eye or facial problems. Mild telecanthus that does not affect vision or self-esteem may not require treatment. [1]

The best approach depends on whether the condition is congenital or traumatic, whether there are other health concerns, and how the person feels about the appearance or function of the area. A specialist can explain the potential benefits and limitations of treatment.

Tendon shortening and fixation

Tendon shortening and fixation are usually used for congenital telecanthus. A surgeon shortens the medial canthal tendons to the appropriate length and secures them to a bone between the side of the nose and the eye socket. [1]

Transnasal wiring

Transnasal wiring is usually used for traumatic telecanthus. A surgeon detaches the medial canthal tendon from the affected eye, repositions it and secures it to the skull with very thin wire. The wire passes through small holes made in the inner eye socket and nose bones. [1]

Treatment approach	Usual context
Observation	Mild telecanthus that does not affect vision or self-esteem may not need treatment.
Tendon shortening and fixation	Usually used for congenital telecanthus.
Transnasal wiring	Usually used for traumatic telecanthus.
Supportive counseling	May help with self-esteem or emotional concerns related to appearance.

What is the outlook for telecanthus?

Telecanthus does not worsen with age and usually does not require treatment. When surgery is performed, it is usually effective. However, the inner eyelid corners may move closer together again after surgery, and some people may need a second operation. [1]

The long-term outlook also depends on the underlying cause. Telecanthus associated with a genetic disorder can occur alongside developmental delays, learning disabilities, or problems involving the heart, lungs, gastrointestinal tract and other organs.

Can telecanthus affect vision?

Telecanthus alone usually does not cause vision problems. Vision concerns may occur when it appears with other eye abnormalities or with a genetic syndrome that affects eye development. Possible problems include low vision, myopia and hyperopia. [1]

A healthcare provider can determine whether vision testing or an eye-care evaluation is appropriate. The appearance of telecanthus should not be used to assume that a child has a vision disorder or a particular genetic condition.

Can telecanthus be prevented?

Telecanthus cannot be prevented, though people worried about passing on a genetic disorder can discuss genetic counseling with a healthcare provider. People who are concerned about passing a genetic disorder to their children can discuss genetic counseling with a healthcare provider. [1]

For telecanthus caused by facial trauma or a tumor, prevention depends on the underlying situation and cannot be reduced to one general measure.

What is the difference between telecanthus and hypertelorism?

Telecanthus affects the distance between the inner corners of the eyelids. The distance between the outer eyelid corners and the pupils is not affected. The eyes may not appear far apart overall, but the inner eyelids may look farther from each other. [1]

Hypertelorism affects the distance between both the inner and outer eyelid corners and the pupils. It may make the eyes appear farther apart overall. Both telecanthus and hypertelorism can be associated with genetic disorders. Telecanthus is sometimes called pseudohypertelorism. [1]

Condition	What is farther apart or changed?	Key distinction
Telecanthus	Inner corners of the eyelids.	Outer corners and pupils are not affected by the eyelid spacing itself.
Hypertelorism	Inner and outer eyelid corners and the pupils.	The eyes may look farther apart overall.
Pseudohypertelorism	A term sometimes used for telecanthus.	It reflects the appearance of wider spacing between the inner eyelids.

What is the difference between telecanthus and epicanthus?

Epicanthus is a fold of skin on the inner part of the upper eyelid that extends over the inner corner of the eye. An eye-care specialist may call it an epicanthal fold or refer to monolid eyes. Epicanthus and telecanthus often occur together. [1]

Telecanthus describes the spacing between the inner eyelid corners. Epicanthus describes a skin fold in that area. They are different findings, even though they may appear at the same time. [1]

What is the relationship between telecanthus and BPES?

Blepharophimosis-ptosis-epicanthus inversus syndrome, or BPES, affects how the skin around the eye develops and often includes telecanthus. BPES may also include blepharophimosis, epicanthus inversus and ptosis. You can read an overview from MedlinePlus Genetics. [1]

Blepharophimosis means the eyelids are very narrow or underdeveloped and do not open fully. Epicanthus inversus describes a fold of skin on the inner lower eyelid that extends upward over the inner eye corner. Ptosis means the upper eyelid droops or sags. [1]

Questions to ask a healthcare provider

Question	Why it may help
Does my child have other eye problems besides telecanthus?	Helps clarify whether vision or eye development needs additional evaluation.
What is causing the telecanthus?	May distinguish a congenital finding from an injury, illness or associated condition.
Does telecanthus need treatment?	Mild cases may not require treatment.
Would imaging or genetic testing be useful?	The provider can explain whether CT, X-ray or genetic testing fits the evaluation.
When could corrective surgery be considered?	A specialist can discuss timing and the reason for surgery.
How can we support a child’s self-esteem?	Emotional support may help if appearance-related concerns affect well-being.
Who should be part of the care team?	Oculoplastic, head and neck, eye-care, genetic or other specialists may be involved.

Conclusion: Understanding telecanthus with clarity

Telecanthus is an increased distance between the inner corners of the eyelids. It is usually congenital and often occurs with a genetic disorder, but facial trauma, tumors and surgery near the inner eyelids can also cause it. [1]

Telecanthus itself usually does not cause pain or vision problems. The most important next step is understanding whether it is isolated or associated with other eye, facial, skull or health findings. Measurement, physical examination, imaging and genetic testing may be used when appropriate. [1]

Surgery is the main treatment when treatment is needed, although mild telecanthus may be observed. Treatment decisions can consider vision, associated conditions, appearance-related concerns and the person’s or family’s goals. [1]

Frequently Asked Questions

What does telecanthus look like?

Telecanthus looks like an increased distance between the inner corners of the eyelids. The inner eyelid corners are called the medial canthi.

Is telecanthus a disease?

Telecanthus is a physical finding rather than one single disease. It is often associated with a genetic disorder, but it can also follow facial trauma, a tumor near the inner eyelid, or surgery in that area.

Is telecanthus painful?

Telecanthus itself usually is not painful. Pain or other symptoms may relate to an associated eye condition, injury, or another cause.

Does telecanthus affect eyesight?

Usually not by itself. Vision problems can occur when telecanthus appears with other eye abnormalities or conditions affecting eye development.

Is telecanthus present at birth?

Usually. Congenital telecanthus is present at birth, although adults can rarely develop it after trauma or an illness that changes the shape of the face.

How is telecanthus diagnosed?

A healthcare provider may measure the distance between the inner eyelid corners with a special ruler and may order a CT scan, X-ray, or genetic testing depending on the findings.

Does every child with telecanthus need surgery?

No. Mild telecanthus that does not affect vision or self-esteem may not need treatment. Surgery is the main treatment when treatment is chosen or needed.

What type of surgery treats telecanthus?

Tendon shortening and fixation are usually used for congenital telecanthus. Transnasal wiring is usually used for traumatic telecanthus.

Can telecanthus come back after surgery?

The inner eyelid corners may move closer together again after surgery, and some people may need a second operation.

What is pseudotelecanthus?

Pseudotelecanthus, or secondary telecanthus, is an appearance caused by swelling, scarring, or fluid buildup after an injury that makes the inner eyelids look farther apart.

What is the difference between telecanthus and hypertelorism?

Telecanthus affects the inner eyelid corners. Hypertelorism affects the distance between the inner and outer eyelid corners and the pupils, making the eyes appear farther apart overall.

What is the difference between telecanthus and epicanthus?

Telecanthus describes wider spacing between the inner eyelid corners. Epicanthus describes a skin fold over the inner corner of the upper eyelid. They can occur together.

Can telecanthus be prevented?

There is no way to prevent telecanthus. Genetic counseling may help people who are concerned about passing genetic disorders to their children.

Related Reading

Waardenburg Syndrome: Causes, Symptoms, and Clinical Types explains a genetic condition in which telecanthus is a key feature.

Facial Fractures: Types, Symptoms, Causes, Diagnosis, Treatment and When to Go to the ER — What You Need to Know covers facial injuries that can cause traumatic telecanthus.

Down Syndrome: Symptoms, Causes, Types & Life Expectancy — Complete Guide explains a chromosome condition sometimes linked with telecanthus.

Fetal Alcohol Syndrome: What Causes It, What to Look For, and How Early Help Changes Outcomes describes alcohol-related birth differences that can affect facial features.

References

1. Cleveland Clinic. Telecanthus. Cleveland Clinic. Last updated November 29, 2022. https://my.clevelandclinic.org/health/diseases/24483-telecanthus

2. National Library of Medicine. Blepharophimosis, ptosis, and epicanthus inversus syndrome. MedlinePlus Genetics. Last updated October 1, 2013. https://medlineplus.gov/genetics/condition/blepharophimosis-ptosis-and-epicanthus-inversus-syndrome/

3. Song X, Jia R, Zhu H, et al. A modified staged surgical intervention for blepharophimosis-ptosis-epicanthus inversus syndrome: 125 cases with encouraging results. Ann Plast Surg. 2015;74(4):410-417. PMID 24164792. https://doi.org/10.1097/01.sap.0000437072.17014.41

4. Elbarbary AS, Ali A. Medial canthopexy of old unrepaired naso-orbito-ethmoidal (NOE) traumatic telecanthus. J Craniomaxillofac Surg. 2014;42(2):106-112. PMID 23731578. https://doi.org/10.1016/j.jcms.2013.03.003

Disclaimer

This article is for general educational purposes and is not a substitute for professional medical advice, diagnosis or treatment. Always seek the advice of a qualified health provider with any questions you may have regarding a medical condition.

It is not a diagnosis, genetic counseling session, surgical recommendation or personal treatment plan. A change in eyelid appearance, vision, pain, swelling or facial shape can have different causes, and a qualified healthcare provider should evaluate individual concerns. A child’s appearance does not define their health or identity.