In Vertical Orbital Dystopia Correction Will The Tear Duct Position Move?

Q: Dr. Eppley, Hello again, I first reached out to back in 2013 (inquiring about correcting my ocular Dystopia in my left eye. 

I feel I’m ready to finally have the procedure done.Attached Image on the Left was in 2013 , image on the right was a few months ago. 

As I mentioned before this has always effected my confidence and has been a large contributing factor to the depression I struggle with. 

You said I you felt you could improve my situation and that from the photos it appears that I have 3mm to 4mm of dystopia. Since last we spoke I’ve reviewed your website and noticed that plastic inserts are sometimes used to raise the orbital floor. I’ve also read in some cases you also lower the higher eye in addition to lifting the lower one. 

Two concerns that I have is that in addition to the lower position of my left eye, my tear ducts are also not aligned, would this cause a separate issue as that is fixed tissue? 

Also the shape of my right eye level slants up toward the inside where my left slants down. I’m concerned that if we are able to raise the eye, this might actually make things worse due to the eye lids also being different. 

Does that make sense? 

In addition to the eye surgery, I’d like to consider having my chin corrected to be more symmetrical as well. It slants (left) to the side of my lower eye.

A: Thank you for your repeat inquiry as I still have your initiual inquiry and picture on file from 2013. In answer to your question:

  1. It does appear that the left eye is a few millimeters lower than the right. It would take a 3D CT scan to confirm what the actual differences are. Most patients get their CT scans in their local area but one can also be obtained here.
  2. You are correct in that the tear duct position is fixed.
  3. In almost all cases of VOD surgery the eyelids/eye corner must be addressed at the same time. Moving up the eye will make the overlying soft tissue asymmetries more apparent.
  4. Most VODs do not exist in isolation. They are often part of an overall facial asymmetry in which other facial features have differences as well. Your chin would be an example of that more global facial asymmetry effect. How best to correct that would come from information obtained in the 3D CT scan.

Dr. Barry Eppley

Indianapolis, Indiana