For My Vertical Orbital Dystopia Should I Raise The Lower Eye or Drop Down The Higher Eye?

Q: Dr. Eppley, I have an asymmetric orbital rim problem where my left eye is lower than my right eye. I have taken a picture and drew a red line where the horizontal plane should be. Since I have a long face is it possible to move my right eye down to the same level as my left eye?

A:Thank you for your inquiry and sending your picture. In vertical orbital dystopia the debate is whether to raise the lower eye (orbital floor augmentation) or drop down the higher eye. (orbital floor downfracture) The augmentative operation is moron predictable because you are directly choosing the amount of orbital floor augmentation. Trying to drop down the higher eye is a bit more unpredictable as how much the the orbital floor should be lowered is not always 1:1 with the vertical position of the eye. Preoperative assessment with a  3D CT scan of your bony orbits would provide further insight into that consideration.

Dr. Barry Eppley

Indianapolis, Indiana