Orbital Bone Reshaping

Q: Dr. Eppley, what are some ways that you can bring deep set eyes forward? I have eyes that sink back more than normal giving the appearance of enophthalmos. I’ve read about orbital floor implants, injections to prop eyeball up and more forward to protrude. This is my biggest insecurity is that my eyes are sunken in and if they were protruding the eyelid would be stretched out more and not deflated and flat because of how retruded my eyes are. Also I’ve read about shaving the zygomatic bone and brow bone to make the eye look more protruded, is that a surgery you preform? Retruded eyes makes my nose look even longer than it is. My nose bridge is a bit too narrow and long. I do want the nose shortened and the entire bridge as well as between my eyes widened wether that’s done with bone cement, fat grafting, cartilage grafting to give my eyes the illusion of being even more further apart. What are your thoughts on this?

A: There really is no way to bring the eyeball forward. It is important to remember that the eye is tethered like a string by the optic nerve. So the concept of trying to bring it forward puts tension on the optic nerve and may risk blindness. While the eye can be made to be raised or lowered, these are vertical changes that do not stretch the optic nerve.

What can be done to make the eye more prominent is to reduce the bone around it. The brow bones and lateral orbital rims can be reduced to set back the bone which can make the eye look a few more millimeters forward.

To make the eyes look further apart I would not think that widening the nasal bones would create that look. If anything that would make them look closer together as the distance between the inner corner of the eyes and the nasal bone is becoming shorter. Widening the nasal bones does not push the eye outward.

In short, while orbital bone reshaping can be done its effects on making the eyes look more forward would probably be negligible.

Dr. Barry Eppley
Indianapolis, Indiana