I was punched in the eye 10 years ago. I'm not sure if it's my eyelid or eye socket that was damaged I think my left eye is depressed slightly downward and is positioned slightly higher than my right eye, but I saw a plastic surgeon in LA who is a oculoplastic surgeon who has done eyelid surgeries and complex orbital fracture repair who said he thinks left eyelid is lazy and it's making my right eye appear larger. He still recommended to get a CT scan to rule. what do you think?
Sunken Eye Orbital Fracture? (photo)
Doctor Answers 6
Definitely need CT
Agree with others.
1. You need a CT scan of the facial bones/orbits. Need to look for evidence of other previous fractures so that you can be treated correctly
2. You need an Ophthalmology exam. Specifically (provided no depressed cheek bone fracture) to get a hertel Exophthalmometer reading. This measurement will tell you if you have a significant difference between the two eyes.
3. If you are not having trouble with vision ie double vision, really consider carefully if you want to do anything at all. As a surgeon that frequently treats facial fractures, delayed orbital fractures can be difficult and come with a risk (albeit tiny) of blindness in the affected eye.
cheers and good luck.
I agree a CT scan is necessary to evaluate the boney structure of the orbits. Without the CT it will be difficult to decide what is causing the asymmetry.
CT scan is appropriate
I was able to magnify your photos to better evaluate the eye position, and I do get the impression that the right eye is slightly more prominent [bulgy] than the left eye [or put another way, the left eye is slighty more sunken in].
The difference is subtle, and difference within 2 mm is considered to be within the normal range.
I do not appreciate a "lazy eye" from the photos, but that may be something that your surgeon may have picked up on an eye exam.
A CT scan is very reasonable next step to better appreciate the difference in anatomy.
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It's difficult to see much with these photos. Your left eye appears deviated inward. A CT is reasonable, but there is radiation exposure with a CT. I would consider seeing an ophthalomologist who specializes in strabismus, "lazy eyes", before having the CT. This way you may avoid the radiation.
Sunken Eye Orbital Fracture?
I agree that you should get a CT scan to evaluate what is going on regarding your orbit. Your photos aren't good enough to give you an opinion regarding the cause of the eye asymmetry.
CT Scan after Trauma
Get the CT scan. It is best to have all of the information at your disposal before considering a surgery that may not fix your problem. You do not have pictures of your cheek included but a ZMC fracture or orbital fracture can produce orbital volume changes that should be addressed due to functional issues or cosmesis. If the eyeball is sunken and given the mechanism, the most likely conclusion would be fracture to increase the volume of the orbit. Kenneth Hughes, MD Los Angeles, CA
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