Female, 54, dry eyes - what procedure would you suggest to improve eye symmetry? (Photo)

Question

I am self conscious about the asymmetrical appearance of my eyes . What procedure(s) would you suggest for best result? F, 54, dry eye

Muhsin Yilmaz, MD, FEBOPRAS · Answer

The best procedure depends on what is actually causing the asymmetry. It could be related to differences in upper eyelid skin, eyelid crease, brow position, fat distribution, or eyelid ptosis. An upper blepharoplasty may help in some cases, but it is important not to assume that removing skin alone will correct the asymmetry.
Because you already have dry eyes, I would recommend a careful evaluation by an experienced oculoplastic surgeon before considering surgery. Your tear film and ability to fully close the eyes should be assessed, and any dry-eye symptoms should be well controlled beforehand.
Depending on the findings, treatment could involve upper blepharoplasty, ptosis correction, brow adjustment, or a combination of procedures. A conservative approach is particularly important in someone with dry eye.

C. Blake Perry, MD · Answer

Judging from your photo, it appears you have left upper lid retraction. This can be caused from numerous things, the most common being Thyroid Eye Disease. Upper lid retraction can also lead to dry eyes. You need an in-person consultation with an oculoplastic surgeon to help determine the cause and appropriate treatment.

Kenneth D. Steinsapir, MD · Answer

One eyelid is more retracted than the other. When the eyes are this open, it is associated with the “deer in the headlights” look. The most common cause for this is thyroid related eye disease. Retraction of the eyelid can be associated with dry eye. Thyroid eye disease can cause orbital inflammation and also contribute to dry eye. I strongly encourage you to be assessed by an Oculoplastic surgeon. They will assess the basis for the retraction and investigate if you have thyroid eye disease and best management options. The American Society for Ophthalmic Plastic and Reconstructive Surgery (ASOPRS) maintains a directory on their website that can help you identify a highly qualified oculoplastic surgeon close to home.

Michael McCracken, MD · Answer

You may have some bulging of one eye as the cause of the asymmetry.  The most common cause is thyroid eye disease (even with normal thyroid hormone levels), but there are other causes.  I recommend you seek a consultation with an oculoplastic surgeon.  You can find one near you at asoprs.org.

Julian De Silva, MD · Answer

Thank you. Two things stand out from your message. First, some degree of difference between the two sides is normal and very common, and a single photo cannot tell me whether your asymmetry comes from upper-lid skin, brow height, lower-lid position, or a small natural difference in the eye sockets. Second, and importantly, you mention dry eye. That matters a great deal here, because eyelid surgery, particularly anything that removes skin or lowers the lid, can make dry eye worse if it is not planned around. In someone with dry eye I am more conservative: I test tear function before surgery, and I sometimes recommend treating the dry eye first. So the right next step is an in-person assessment that looks at the eyelids and the eye surface together, not the eyelids alone. Once I understand what is driving the asymmetry and how your eyes tolerate it, the treatment is usually modest. Please do not rush into skin removal until the dry eye has been factored in.

Female, 54, dry eyes - what procedure would you suggest to improve eye symmetry? (Photo)

Answers (5)

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