Q: Dr. Eppley, I have asymmetric eyes, the left eye is 3 millimeter lower than the right. I do not have double vision. Can I have the surgery to move my left eye up and into a more correct horizontal position? I really thank you for answering my question. I have attached a picture which shows the difference between my two eyes.
A: Thank you for sending your picture. Your entire orbital ‘box’ on the left side is shifted downward, otherwise known as orbital dystopia. This is a more challenging problem to fix that it initially seems because of the existing ptosis (sagging) of the upper eyelid. The brow bone above will need to be vertically shaved (raised)and the orbital floor augmented. The problem is that this will raise the eye upward but it will become more ‘buried’ under the upper eyelid than it is now. This will require either a simultaneous upper eyelid ptosis repair or have the ptosis repair done as as second stage procedure 3 to 6 months later. The problems with ptosis repair at the time of other orbital procedures is that the eyelid adjustment is being done when everything else is being changed. It would be highly unlikely that the upper eyelid position would be correct or ideally located on the newly elevated eyeball.
Thus while there can be major improvement in your left orbital dystopia, I would not think of it as only a one-stage operation.
Dr. Barry Eppley