Do I Have Negative Eye Vector or Sclera Show? (photo)

Hello, I have noticed that my eyes have a relatively buldgy appearance and am not completely sure if this is due to possible having negative eye vector or scleral show. Maybe it's something completely different, any help on this matter would be greatly appreciated. Thank you.

Doctor Answers 6

Treatment for bulging eyes

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You have a very proptotic or bulging globe as well as some hypoplasia of the cheek bone area.   I would agree that you need a medical as well as plastic surgical evaluation to determine your best options.  

Atlanta Plastic Surgeon
4.5 out of 5 stars 20 reviews

Eye Vector

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It is very important to get some history and lab work regarding your current state.  There are several medical conditions that need to be discussed and evaluated regarding your scleral show, etc.

Robert Shumway, MD
San Diego Facial Plastic Surgeon
5.0 out of 5 stars 12 reviews

Scleral show and retruded cheek bones

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From your posted photos it looks like you are correct and have both scleral show and a negative vector (retruded cheek bones). You would need to see a surgeon face to face in order to understand all of the options available to you to address this if you want it changed. Don't let anyone talk you into a lid tightening procedure because that would only make this worse.

My response to your question/post does not represent formal medical advice or constitute a doctor patient relationship. You need to consult with i.e. personally see a board certified plastic surgeon in order to receive a formal evaluation and develop a doctor patient relationship.

Aaron Stone, MD
Los Angeles Plastic Surgeon


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You appear to have a “scleral show” which most likely is a familial trait. You asked about the medical term “negative vector”. A negative vector refers to a plane of the cheek area that is recessed from the plane of the eyeball so that the underside of the eyeball does not have as much support as someone whose cheek plane is continuous with the plane of the eyeball. From a review of your photos, you may also have some negative vector of your face, which is seen often in African American faces. In order to achieve a decrease in these features, you would probably need some bone augmentation of the orbit under the eye and some eyelid grafting procedures. This would be not only expensive, but most likely would not have a great aesthetic effect. There is the risk that you would look like someone who just came through an accident. I think that if you want to soften the effect of your prominent eyes, you may want to work a little on the negative vector and consider submalar (cheek) enhancements such as fillers or implants which would balance out your eyes and deflect some attention away from them.

Amiya Prasad, MD
New York Oculoplastic Surgeon
4.4 out of 5 stars 80 reviews

Bulgy eyes and weak cheek/midface bone

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You are actually quite astute in your evaluation. You have a combination of bulgy eyes [medical term is proptosis or exophthalmos] and negative vector caused by malar hypoplasia [underdeveloped midface bone].

If you have had this appearance your whole life, then it is unlikely that there is a medical condition that is the cause. Thyroid disease is usually the medical problem that will cause bulgy eyes.

There are a few different ways to address this, depending on how aggressive we want to be. First there is Orbital decompression. This is a surgery whereby the eye socket volume is increased by removing bone from inside the socket, in effect making the "room bigger for the eye". There are some risks to surgery, such as double vision, but these risks can be minimized with certain techniques.

Another option is to augment the cheek bones with implants. THis can help reduce the "negative vector" that you described. These procedures can be combined.

Although many different types of surgeons may be experienced in this surgery, Oculoplastics surgeons more commonly deal with this issue.

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.

A.J. Amadi, MD
Seattle Oculoplastic Surgeon
5.0 out of 5 stars 42 reviews

Prominent globe and negative vector

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It is possible to improve the appearance of lower eyelids that are very prominent, especially if there is considerable scleral show.

Usually, this involves a cheeklift procedure with slight canthal adjustment.

Augmentation of the cheek region with grafts is also a frequently used option as well.

Brent Moelleken, MD
Beverly Hills Plastic Surgeon
4.9 out of 5 stars 195 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.