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What causes sanpaku eyes (and what the hell are sanpaku eyes)?
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What causes the condition known as sanpaku eyes? Is it indicative of any physical or mental health issues? —Bill Ross, Pittsburgh

FIRST off, Bill, “sanpaku eyes” isn’t exactly a medical term. And second, the phenomenon the phrase refers to isn’t a medical condition, but rather a not wildly uncommon physical trait—it’s like you’re wondering about the condition known as dimples.

The average reader will now be thinking: What the hell are we even talking about? Sanpaku describes eyes in which the sclera—the white part—can be seen above or (usually) below the iris. The word is Japanese, from elements meaning “three” and “white,” the idea being that the iris is bounded by sclera on three sides, rather than the usual two.

Whatever dent the sanpaku concept has made in the Western consciousness is largely the doing of George Ohsawa, a Japanese thinker who last century helped bring to the wider world the dietary philosophy called macrobiotics, which emphasizes maintaining one’s yin-yang balance via intake of various whole foods. Ohsawa poached the concept of sanpaku from old Asian diagnostic traditions of facial reading, in which different features were thought to reflect aspects of your physical or spiritual health. In his writings Ohsawa claimed that three-whites was a particularly nasty characteristic, indicative of someone “suspicious, fearful, insecure, quick to misunderstand, and passive.” Furthermore, “his heart, sexual organs, liver, kidney, and lungs are very sick,” and so forth, and the condition can only be treated with a macrobiotic diet.

Ohsawa came armed with examples, too: his list of prominent people with sanpaku included John F. and Robert Kennedy, Hitler, Abraham Lincoln, and Marilyn Monroe. And to the extent anyone’s aware of the trait today, it’s because they’ve heard this roster of unfortunates, which has since been expanded to include John Lennon and Elvis. Then there’s Charles Manson, who had the dreaded “upper sanpaku,” in which the white is visible above the iris—thought to indicate a dangerous psychopath. Clearly this group had its share of high-profile troubles, one concedes, but not ones that could have been foretold from the visibility of their sclera.

Or could they? Several sources on sanpaku point with satisfaction to an August 1963 interview (by Tom Wolfe, no less) of George Ohsawa in the New York Herald Tribune, in which he’s said to have predicted JFK’s death. Online Herald Tribune archives, though, stop in the year 1962, leading one to wonder: Just how high up does this thing go, anyway?

Obviously you’re not buying this theory, Bill. Is there anything to sanpaku eyes medically, though? Not really—as an isolated trait, nobody ever died from showing too much sclera. But they’re sometimes seen as a sort of benign effect of certain other conditions:

• Ectropion, or eyelid droop, occurs in aging people as their faces lose muscle tone; as the lower lid droops, you might catch a little more white. Possible medical complication: increased irritation due to greater exposed area of the eyeball.

• Retraction of the lower lid, giving the eye a distinctive rounded shape, is a common complication following cosmetic surgery—specifically lower-lid blepharoplasty, which removes lines and tightens the skin..

• Exophthalmos, or proptosis, is a bulging of the eyeball; among the underlying causes can be Graves’ disease (an immune disorder that leads to hyperthyroidism), or eye injury or cancer, etc. This might cause a sanpaku look, but here the most striking aspect isn’t really exposed sclera qua exposed sclera; it’s that your eyes are popping out of your head.

• Finally, a milky white ring around the cornea—not quite sanpaku, but I guess it could be mistaken for such—indicates the presence of lipid deposits. Called corneal arcus or arcus senilis, this is also a byproduct of aging; it doesn’t affect vision.

Anyways, the sanpaku crowd isn’t just swimming against the tide of good science—if we follow one credible theory, they’re up against the whole of evolution. Among species, humans possess notably visible and well-demarcated sclera. According to the cooperative eye hypothesis, that’s by design. It’s thought that our eyes evolved to look this way so we’d be better able to communicate—by reading one another’s eyes and tracking each other’s gazes. So more may be better when it comes to the sclera, though I hope this doesn’t mean Charles Manson is the next step in human development.