Orbital Dystopia

Q: Dr. Eppley, I have orbital dystopia with my left eye being lower than my right. Will the placements of orbital floor implants correct the misalignment and depth of eyeball?

A: Correction of orbital dystopia is very challenging for a variety of reasons. First one can not just move the eyeball anywhere one wants by changing the volume inside the orbit because of the optic nerve. Care must be taken to not put too much pressure on the eye as the low but real risk of visual loss is ever present. Secondly, the increase in interorbital volume is always multifactorial and changing the size of the interorbital space through implant augmentation affects just one of these factors. Lastly, there is no scientific method to know exactly how much to augment the orbital floor and where. All that can be done is to take measurements and make a 3D implant from them to match the other side.

It is best to think about improvement in the position of the eye rather than absolute correction. There is also the issues of how the overlying eyelids (upper and lower) adapt to an elevated eyeball. Usually adjustments of eyelid position are also needed.

Dr. Barry Eppley

Indianapolis, Indiana