Orbital Asymmetry

Q: Dr. Eppley, I am inquiring about orbital asymmetry surgery. I suffered a zygomatico-maxillary complex (ZMC) fracture six months ago and have since had noticeable asymmetry of the orbits. The right orbit (injured side), is now noticeably higher than the left orbit. The right orbit was slightly higher than the left prior to the injury, but not to the current degree seen in the attached image. The medial portion of the eye is at an upward slant compared to the left eye which is more level.

A: Such orbital asymmetry would suggest an impaction type ZMC fracture. This could create an inward translocation of the inferior orbital rim/zygomatic body. This would then cause a buckling of the orbital floor upward, creating the changes you see now. But the etiology of these changes is best assessed by a 3D CT scan which would clearly show whether any asymmetry exists between the two orbital floors.  If orbital floor asymmetry exists then lowering of the raised part of the orbital floor may be beneficial as an orbital asymmetry surgery. This could be done through a lower blepharoplasty incision to allow complete access to the entire orbital floor.

Dr. Barry Eppley

Indianapolis, Indiana