My eyes are not equal in size they are up and down. How can I rectify this? (photos)

Question

I had a attack of fits since 9 or 10 years ago I took complete treatment right now I am completely fit and fine, after that my eyes are not in equal shape or size, how can I rectify it please give me useful suggestion, is a side effect of medicines or something else??

Amiya Prasad, MD · Answer

Thank you for your question. You state you’ve been dealing with “fits” for the past 9 to 10 years, but are currently under control with medications. You are concerned about the left upper eyelid being lower than the right.
I can share with you my approach to what I see in the photos, in the absence of a physical examination. A little background: I’m a Board-certified cosmetic surgeon and Fellowship-trained oculofacial plastic and reconstructive surgeon. I have been in practice in Manhattan and Long Island for over 20 years. Dealing with eye asymmetry, particularly with the condition called ptosis has been a very significant part of my career. I think I can share with you my approach to doing an evaluation, and then recommendations. 
Understanding the term “fits” means seizures or epileptic seizure, I think we can establish you had these seizures which required some medications to control. I wonder if during any of these episodes, you had trauma that caused swelling of the eye area, bleeding, or hematoma in these areas which would make me think of a trauma induced ptosis, but let’s backtrack a little. 
The left upper lid being lower than the right upper eyelid is referred to as ptosis, meaning drooping. The ideology of ptosis is very important. In traumatic ptosis, there is a trauma from a physical assault, motor vehicle accident, or something that causes a tremendous amount of swelling that can cause the levator muscle that lifts the eyelid, to stretch or detach so the eyelid droops. 
Then is also neurogenic ptosis which means there is a neurologic issue, which can’t be diagnosed with just photos alone. I recommend you see a neuro-ophthalmologist to check your eye movements to determine whether or not there are other eye muscle abnormalities occurring with the ptosis, and whether further investigation or imaging would be indicated. 
The more common solution we offer for ptosis that’s not caused by a neurological issue, but caused by the eyelid muscle being stretched or separated is ptosis surgery. We move the muscle that lifts the eyelid whether by shortening it, moving it forward, then reattach it based on the examination and a ptosis evaluation. In a ptosis evaluation I’m looking at the position of the eyelid, the eye muscle function by having the patient look down and look up, and other ophthalmologically relevant features or signs. I then determine whether or not this is something amenable to this type of surgery. 
During ptosis surgery, after the muscle is placed, I ask the patient to open their eyes,  have them sit up so I can look at their eyes in a normal position with gravity, and I make the adjustments necessary. We lay them back, and do this a couple of times until we get the satisfactory height, shape and contour to maximize symmetry. The golden rule is it should look good in the operating room, otherwise it won’t look good outside of it. A certain percentage of people do need some enhancement, whether it’s overcorrection or undercorrection, but that’s the reality of doing this type of surgery. 
I think it’s best for you to see an ophthalmologist or a neuro-ophthalmologist first to rule out the other neurologic basis, and to make sure there are no other neurologic cause that needs to be pursued. Once that’s accomplished and you’re cleared, then an oculoplastic surgeon can help you with the ptosis surgically. I hope that was helpful, I wish you the best of luck, and thank you for your question.This personalized video answer to your question is posted on RealSelf and on YouTube. To provide you with a personal and expert response, we use the image(s) you submitted on RealSelf in the video, but with respect to your privacy, we only show the body feature in question so you are not personally identifiable. If you prefer not to have your video question visible on YouTube, please contact us.

Paul Nazemi, MD · Answer

Your issue can be treated.  One of your eyelids is droopy (ptosis) likely from the trauma that you experienced.  This can be corrected with a ptosis procedure.  See an oculoplastic specialist for a consultation to learn more about your condition and the procedure.

My eyes are not equal in size they are up and down. How can I rectify this? (photos)

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My eyes are not equal in size they are up and down. How can I rectify this? (photos)

Answers (2)

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Everything you need to know about Eyelid Surgery

Our mission is to create a world where every investment in modern beauty is Worth It.