Orbital Decompression? Insecure about my uneven, bulging eyes. (photos)

Question

Growing up, I have always been insecure about my eyes, especially when it came to photos because I’d always focus on my uneven eyelids and the white space above my lower eyelids. I’ve also been always told I have big eyes or bug eyed. Im not sure exactly what procedure would exactly work for me but orbital decompression seems to be the only option that would work for me. Would I be a good candidate for this? Is there something else that might work better like a blepharoplasty?

Kenneth D. Steinsapir, MD · Answer

From your photographs, you appear to have a relative lack of projection of the inferior orbital rim. This is called "semi-exopthalmos." It makes the eyes appear prominent but from the photographs the relationship of the superior orbital rim to the globe appears normal. An orbital decompression generally removed bone and some soft tissue from the orbit, the term for the bones that make up the eye socket. This makes room to accommodated a prominent eye and it is very helpful in conditions like thyroid eye disease in individuals whose orbital contents have enlarged from thyroid eye disease. In my opinion based on these photographs, an orbital decompression is not the right approach. You would benefit from an orbital rim implant placed where the bone of the inferior orbital rim is weak. This would support the cheek projection and address the semi-exophthalmos without the high risk of complications associated with orbital decompression. There is no substitute for a detailed in person consultation. I recommend avoiding office that would plan surgery for you based on a zoom call.

Lauren D. Mileo, MD · Answer

Some patient have more "scleral show" which is the white part between your eye and your lower eyelid. This is often due to anatomy and the relationship between your eye, eyelid, and eye socket. Sometimes the eye protrudes farther out of your eye socket due to systemic issues such as thyroid/autoimmune conditions. An orbital decompression is a surgery that enlarges your bony eye socket to create more space for your eye (and make it not protude as much). It is a very big surgery, and you need proper evaluation with bloodwork and imaging to determine if you are a candidate. You can also consider eyelid surgery (canthoplasty) to bring the lower eyelid higher up but that will change the overall shape of your eyes. For these surgical evaluations you should seek a consultation with an oculoplastic surgeon.

Orbital Decompression? Insecure about my uneven, bulging eyes. (photos)

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Orbital Decompression? Insecure about my uneven, bulging eyes. (photos)

Answers (2)

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