Q: Dr. Eppley, I stumbled upon your case study for vertical orbital dystopia when researching potential corrective procedures for just that. I’m a 27 year old male who has orbital dystopia with about the same severity as the guy in your study and I’m curious what the ballpark price would be for such a procedure. I’ll gladly send you a picture, or provide you with any other information you might need.
A: Thank you sending your pictures. It appears you have about a 5mm horizontal discrepancy as based on the position of the pupils. The is probably just within the range of what can be improved by an orbital floor/orbital rim augmentation procedure. This can be accomplished by either using hydroxyapatite cement for the buildup or using a 3D CT scan to make a custom implant.
The bony augmentation aside, the real key to a successful aesthetic outcome in vertical orbital dystopia is how the lower eyelid is managed. For the lower eyelid must be elevated with the globe or an increased amount of scleral show will result. At the least this requires a lateral canthoplasty, which may or may not, require a mucosal spacer graft.
Dr. Barry Eppley