A number of variations of congenital deformities are included under the heading of congenital palpebral phimosis. In general, the main problem is the narrow dimensions of the interpalpebral fissure, both horizontal and vertical. One of the main features is the wide intercanthal distance with various types of epicanthal skin folds at the medial canthus.
The child with this condition usually has a rather flat face, with very little of the normal depression at the medial canthus, and consequently little or no nasal bridge. In addition, he holds his head far back to be able to see out of the narrow interpalpebral fissures, which are little more than slits in severe cases. The ptosis is aggravated when the interpalpebral fissure is also short temporally. In milder cases the condition of the lateral canthi may be quite normal. There is almost always a lack of the transverse fold in the upper lid
HUGHES WL. Surgical Treatment of Congenital Palpebral PhimosisThe Y-V Operation. AMA Arch Ophthalmol. 1955;54(4):586-590. doi:10.1001/archopht.1955.00930020592012