One eye is bigger than the other? (photos)
Doctor Answers 8
You appear to have upper eyelid retraction, which needs examination if it was always present, or if it was acquired
Thank you for the question. You submitted a single photo with your question about one eye looking much larger than the other, or one eye looking smaller than the other. You are asking if this is normal or possibly silent sinus syndrome ,and you want to know what kind of treatment you need.
I can give you some guidance for what you should do based on the single photo and broad question. A little background: I’m a Board-certified cosmetic surgeon and Fellowship-trained oculofacial plastic and reconstructive surgeon. I’ve been practicing in Manhattan and Long Island for over 20 years, and the asymmetric appearance of eyes is something I deal with very often because one of the eyelids is droopy compared to the other, as well as one eye being too open compared to the other.
I’ll explain some terminologies and give you my opinion based on just my initial examination of your photo. When I look at your photo, your left eye looks considerably more open than your right eye - the medical term for that is eyelid retraction, meaning the eyelid is more elevated or pulled open. You can have upper eyelid retraction, or lower eyelid retraction, or have both. Since there is no side view, the question also is whether or not that eye is more prominent, or whether it is pushed forward, which is called proptosis. With this understanding, is this something you’ve always had? Some people are born with congenital eyelid retraction, but it is not very common, and I’ve performed surgery to lower the retracted eyelid of people born with it. I suggest you review previous photos to see if it has always been like this; see if this was present since you were a child.
The most common cause of acquired eyelid retraction is thyroid eye disease, or often called called Graves’ disease from a famous doctor. This is caused by a certain antibody, and we refer to the whole syndrome as thyroid-related immune orbitopathy. With a new onset of eyelid retraction, almost doctor you meet will ask about your thyroid, so it is very important you pursue a medical workup. It is very difficult for you to self diagnose and prescribe, so you need to have a good medical work up. I have done a lot of work with thyroid-related eye disease such as surgery for orbital decompression, and eyelid retraction correction to help normalize the eyes, but the first line of treatment is not eyelid surgery. It is actually about the medical management of the thyroid-related immune orbitopathy if this is the situation for you.
In summary, if you always had this appearance, and if you’ve had a medical workup and there is no evidence of abnormalities so your endocrinologist or medical doctor feels comfortable with the diagnosis not being thyroid eye disease. There are surgical options you can consider, but if this is acquired, then this is just a beginning of a journey. I highly recommend you meet with your medical doctor and with an ophthalmologist to get some opinions about the cause of this asymmetry, especially if it is recently changed or acquired, and move forward from there. I hope that was helpful, I wish you the best of luck and thank you for your question.
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Then there’s what is called Droopy Eyelid (Ptosis), caused by migraines, nerve tissues, an eye infection, an allergic reaction and even aging. You should have this addressed if it causes impairment in vision. It is hard to say if the swelling is due to silent sinus syndrome. One needs to have this confirmed with an xray of the sinuses. Treatment is surgical involving making an outlet for mucous drainage from the obstructed sinus. Your best bet is a consultation with an ENT so that you can determine your best course of action.
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