Can My Orbital Dystopia Be Corrected By An Intra-Orbital Approach?
Q: Dr. Eppley, I am interested in orbital dystopia corrective surgery. I have vertical orbital dystopia as a result of craniofacial trauma when I was a child. There were no orbital bone fractures that I know of.The severity of my condition seems to be very similar to the case study posted on your web page. In your case study, you’ve seem to have done a orbital approach alone. However, research on the web has led me to believe that surgical correction for this deformity can be very complex as stated by these 2 doctors where one describes a very invasive intracranial approach. So my question is would you be able to perform the correction using an orbital approach alone. Attached is a picture of my eyes. I would guess that the right eye is at least 5mm lower than the left. I would like to know what procedure you would recommend.
A: Vertical orbital dystopia refers to one eye being lower than the other as a result of the shape or size of the orbital box (bones) in which the eyeball resides. A 3D CT scan can precisely determine the bony component of the orbital dystopia by looking at the periorbital bones. Generally in cases of 5mm or less orbital dystopia, this is completely correctable by an intra-orbital approach. This is done by building up the orbital floor and inferior orbital tim. In reading the comments from the other doctors, although well intended, they are not accurate in how smaller amounts of orbital dystopia can be treated. By your picture, you are correct in that the eye is about 5mms lower than the left and could be lifted by the described infraorbital approach. Be aware that as the eye comes up, however, it will be further buried under the upper eyelid by a similar amount. This means that the upper eyelid will need to be elevated by a ptosis repair, either done at the same time or as a separate surgery.
Dr. Barry Eppley