One Eye Is Bigger Than Another How To Make Them Symmetrical? (Photo)

My left eye looks smaller than right.when i look downward my right eye looks smaller. ophthalmologist said you have ptosis in your left eye they suggest surgery for correction but they also said chances of overcorrection is high. when i look up double vision is happening in 2nd photo.i don't know it was present from birth or this happened after injury on the head. when i asked my parents they said they noticed this problem when i was 5 year old.please tell me how it can be fixed? Thanks Docs.

Doctor Answers 2

Congenital Ptosis

What your are describing is possibly a variant of congenital ptosis [droopy eyelid from birth] that is called "double elevator palsy". This variant of congenital ptosis involves poor development of the muscle that elevates the eyelid [levator palpebrae muscle] and the muscle that elevates the eye [superior rectus muscle]. These two muscles develop together embryologically,  and occasionally do not develop properly together. That is why you have trouble opening the eye and also have double vision when you look up [second photo]. Depending on how well the levator palpebrae muscle is functioning, there are different techniques that can be utilized to raise the upper eyelid, though risk of inability to fully close the eyelid [lagophthalmos] certainly exists.

Looking at the first photo, I also notice that the entire eye seems to be lower on the right than on the left. This asymmetry may be due to the fact that there is asymmetry of the underlying  bony anatomy of the two eye sockets. A CT scan with 3D reconstruction software can help identify whether this is in fact the case.

If you decide to explore this further, I would recommend consultation with an ASOPRS trained Oculoplastics surgeon. You can find one close to you on the ASOPRS dot org website.

Seattle Oculoplastic Surgeon
5.0 out of 5 stars 37 reviews

You have Levator Ptosis of the Left Eye

While it is not possible to make the diagnosis solely on your photograph, the photograph is very consistent with a condition called levator ptosis.  This is caused by a poor attachment between the muscle that opens your eye and the tarsal plate (the piece of cartilage in your eyelid).  Your brain senses that the eye is not opening as far as it should and it automatically activates the nerves to the muscle.  But because the nerve control between the left and right eyelids is not completely separate, there is over stimulation of the other eye as well causing it to open a little too much.  Your brain also may trigger the nerves to your forehead causing the affected side's (left) eyebrow to go up a bit.  It appears that you may have this as well.  The last thing you tend to see is a very deep eyelid crease on the affected side.  The muscle that opens the eye pulls on both the tarsal plate and the skin. If the attachment to the tarsal plate is poor, the eye doesn't open very well, but the skin attachments may still be good such that the heavily activated muscle ends up pulling the skin back into the eye socket even though it is failing to slide the eyelid up off of the front of the eye properly.

To fix the condition you need surgery.  You either can go through the backside of the eyelid or through the skin.  The backside is an easier procedure and leaves no scar.  However, making a skin incision and fixing it through the front has a higher success rate.

Louis W. Apostolakis, MD
Austin Facial Plastic Surgeon
4.9 out of 5 stars 30 reviews

These answers are for educational purposes and should not be relied upon as a substitute for medical advice you may receive from your physician. If you have a medical emergency, please call 911. These answers do not constitute or initiate a patient/doctor relationship.