How One can be Born with One Eye Appearing Larger, or Develop it Later in Life

By: Amiya Prasad, M.D.

Thank you for the question. You submitted a single photo and you state in your question about your concern about one eye looking much larger than the other or one eye actually looking smaller than the other. You are asking if this is normal and you mentioned in your question about the silent sinus syndrome and you want to know what kind of treatment you need. Well, I can certainly give you some guidance as to what you should do moving forward based on the single photo and broad question. A little bit of 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 a lot 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. So, we will get into some terminologies here and I am just going to give you my opinion based on just my initial examination of your photo. So to me, when I look at your photo, your left eye looks considerably more open than your right eye and the medical term for that is eyelid retraction.

Now eyelid retraction basically means that the eyelid is more elevated or pulled open. So you can have upper eyelid retraction, you can have lower eyelid retraction and you can have both. Now since there is no side view, the question also is whether or not that eye is more prominent or whether it is pushed forward and that terminology is called proptosis.

Now understanding that the question now is, is this something you’ve always had? There are situations where people are born with congenital eyelid retraction and it is not very common but I’ve been taking care of patients and I’ve performed surgery to lower the eyelid of someone who is born with a retracted eyelid and it has always been like that. So my suggestion, review previous photos and see if it has always been like this. See if this was present since you were a child. Now another issue that needs to addressed is the most common cause of acquired eyelid retraction and that brings us to an area called thyroid eye disease. Thyroid eye disease is often referred to by a famous doctor called Graves’ disease. Now what this means is that there is a certain type of antibody and we refer to the whole syndrome as thyroid-related immune orbitopathy.

It is a mouthful but the point is that when it comes to a new onset of eyelid retraction, pretty much every doctor you meet will ask you about your thyroid and so it is very important that you pursue a medical workup. You know, asking how do you treat this and you are doing research and you came up with the silent sinus syndrome, it is very difficult for you to self diagnose and prescribe. But as far as guidance is concerned, I would say that if this is acquired, it is new and not you are born with this, you need to have a good medical work up because thyroid-related eye disease is something I have done a lot of work with and I have done a lot of surgery for everything, procedures like orbital decompression and eyelid retraction surgery to help normalize the eyes but we are getting ahead of ourselves because 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. So again in summary, distinguish whether or not you always had this appearance and if you’ve had a medical workup and there is no evidence of abnormalities, that I should say, that your endocrinologist or medical doctor feels comfortable with the diagnosis not being thyroid eye disease. Well there are surgical options that you can consider but if this is acquired, then this is just a beginning of a journey.

How One can be Born with One Eye Appearing Larger, or Develop it Later in Life

So I highly recommend you meet with your medical doctor. Meet with an ophthalmologist and get some opinions about what is causing this asymmetry especially if it is recently changed or acquired and move forward from that point on. So I hope that was helpful, I wish you the best of luck and thank you for your question!.

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