Orbital Dystopia

Q: Dr. Eppley, I’m curious about surgery for orbital dystopia. I’m in a similar situation to the one described on one of your site’s articles. I have vertical dystopia that doesn’t cause issues with my vision, but makes me uncomfortable about my appearance. I was wondering if this has been done on other patients before, and what the success rate has been.

A: Thank you for sending your pictures. Your case of orbital dystopia is rather classic. The horizontal difference in the level of the pupils is between 3 to 5mms. While the level of the globe (eyeball) can be raised by orbital floor augmentation, it is important to appreciate that as the eye comes up, the attached position of the eyelids will change. This means that the lower eyelid will need to be resuspended through a lateral canthoplasty and the upper eyelid will need to be raised like a ptosis repair. Thus as the eye moves up it will get further ‘buried’ under the upper eyelid and the lower eyelid will be further ‘retracted’ downward. While the lower eyelid can be adjusted at the time of orbital floor/infraorbital rim augmentation. The upper eyelid ptosis repair, however, can not be done at the same time and its repair, if needed, must be done secondarily.

Dr. Barry Eppley

Indianapolis, Indiana