Q: Dr. Eppley, I have an eye problem. My right eye is lower than my left by a few millimeters, I can tell because when I look straight in the mirror it looks lower as judged by the level of the pupil. I got punched in the face about five years around broke some bones around my eye but never had surgery. They said it wasn’t bad enough to have surgery at the time. But my eye has slowly sunk down over time. Is there a way to fix this?
A: What you have is called enophthalmos where the eyeball has dropped lower due to lack of bone support or fat support underneath. Most likely you had an orbital floor fracture which was not significantly displaced so surgery to fix it was not done at the time. But over time, fat atrophy may have occurred which is another well known cause of enophthalmos after such floor fractures. The best approach is to build the floor back up with a synthetic orbital floor implant. The question is whether you have enoughenophthalmos to justifiy the surgery. But then you likely would not be asking me about it if it was irrelevant to you. If done through a transconjunctival approach then the procedure would not create any new skin scars. The risks of such surgery would be persistent undercorrection, overcorrection, implant shifting and potential infection. The aesthetic side of these risks are more likely.
Dr. Barry Eppley