Q: Dr. Eppley, I am seeking orbital dystopia correction. Having seen some of your earlier work regarding orbital surgeries I think you are the best one to know what my options are. I am a male, 25 years old. For as long as I can remember I’ve really been disliking my orbital asymmetry. I don’t know if it’s become worse with age/time but my left “bigger” eye is constantly focusing lower down than the right “smaller” eye. The pupils are never aligned. This phenomenon was a tricky one for me for many years, because it almost mimicks “ptosis” because the lid and the right eyebrow sag down on the same side. But as the pupillary distance is vertically different (1-2mm) that must mean that my eyes are set differently as well. I am so depressed by this discovery that I don’t know how to approach people or even look people in the eyes without wanting to look the other way. The right eye also seem to have a slight slant. When I put my chin to my chest, eyes straight up in the ceiling, the right eye always goes higher up than the left.
It seems my right eye is set further back, thus looking smaller and also makes the lid sag more. But could this be enophthalmos (sunken globe)? Notice the right eye in a few pictures with my head tilted back.
Here in my country, I get zero help from opthalmologists or other specialists, despite having done a lot of research and presented to them. Either they don’t understand the underlying problem or they think I shouldn’t worry or exaggerate it. So my chances of help over here are pretty much limited. So that is why I am contacting you.
A: Thank you for your detailed inquiry and sending your pictures. As you may or may not recall you have previously submitted and inquiry with pictures (which I still have) so I am familiar with your case. The best way to confirm and quantify your orbital dystopia is with a 3D CT scan. It will no doubt confirm that the right orbit is lower than the left. It will also establish by what amount. Beyond the diagnosis the greatest value of the 3D CT scan would be when planning for surgery in the creation of how thick an orbital floor implant would need to be. But an orbital floor implant alone will be inadequate. It has to be combined with a right browlift and upper eyelid ptosis correction. Otherwise all you do is bury the elevated eye up under the eyelid.
Dr. Barry Eppley