One eye is bigger than the other? (photos)

Wanted to ask if this is normal? One eye appears to be significantly smaller than the other, I think it's the upper eyelid of my right eye that appears swollen. However, it doesn't feel swollen, any advice on what it is? I have heard of silent sinus syndrome, what treatment should I receive?

Doctor Answers 8

You appear to have upper eyelid retraction, which needs examination if it was always present, or if it was acquired

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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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Having one eye bigger than other is called asymmetry. There are various causes for this, the most common of which is natural asymmetry. This is when eyes are different in size and shape, typically one eye will be narrower than the other, while the other looks more rounded. In such condition, there is no cause for concern, as it is entirely normal. If you notice that your eyes appear asymmetrical when you are dehydrated or tired, just get plenty of rest and drink lots of fluids; others manage asymmetry through make-up hacks using pale coloured shadow, eyeliner and mascara.

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.

Eye Size

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There are many reasons your eyes could be slight different sizes, it is also normal to have asymmetrical features on your face. With that being said, botox can be placed to change the shape of the eye. I would recommend seeing an oculoplastic surgeon to evaluate you in person. Hope this helps.  

Asymmetric eye shape

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I recommend that  you first  rule out any thyroid hormone abnormalities. Eye lid retraction  is often an early sign of thyroid imbalance. It is best to see your primary care doctor to get the appropriate  blood tests to rule this out.  From a strictly cosmetic perspective, I have found that ultra small dosage of 1-2 units of Botox to the  lower and upper eyelid  of your right eye, will alleviate some of the tightness of the orbicularis oculi muscle. A tense  muscle in this area can cause the eye to appear small and squinty, compared to the  opposite eye.  This is a simple, but temporary, way to make the right eye appear more open and symmetric the  left eye.

I recommend this be done by a board certified  plastic surgeon or oculoplastic ophthalmologist , who can evaluate you and see if Botox  is appropriate for you based on a thorough history and physical exam.

Prashant Soni,M.D.

Asymmetry of the eyes

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An asymmetric appearance of the eyes may have many causes - and therefore, many different treatments. An eye examination is needed to provide specific advice. Silent sinus syndrome may make the eye sink inward, but this is relatively uncommon. Thyroid dysfunction is one entity that can cause proptosis or protrusion of one or both eyes - and is the most common cause of asymmetry of the eye position. You may want to start with your primary care physician to be sure that your thyroid status is within normal, and/or you may choose to go to an ophthalmologist who can take some measurements of the eye position, check your vision and advise if you need further testing. If you have noticed and changes in the vision in either eye, then you should have that checked as quickly as possible. While it is true that we all have some asymmetry, if this photo represents a change in the appearance of your eyes, then a history and physical examination is in order.

One eye is bigger than the other?

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I think the problem may be the left side with left upper eyelid retraction or bulging eye but it could be from the right side. See video below and see an oculoplastic specialist for evaluation.

Asymmetrical eyelids

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Thank you for sharing your concerns. It appears from the photo that the lower eyelid is in the correct position and the higher one is too high. This could be caused by a variety of conditions or simply be natural asymmetry. See an experienced eyelid specialist for comprehensive evaluation and discussion of possible treatment options if needed.
Good luck,

One eye is bigger than the other

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Please don't worry and concern yourself over the asymmetry of your eyes. Everyone is asymmetric. Your eyes not only are different size, but also at different levels. The right eye is higher than the left. These variation from side to is all normal ,and no treatment or correction is needed or recommended.

James Shire, MD
Chattanooga Facial Plastic Surgeon
5.0 out of 5 stars 12 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.