Is the only way to correct Horner’s is with an eyelift, or can the eyeball sinking back
actually be fixed too?
I have Horner’s as a result of a surgery and you can see that my right eye is tucked
back a little as well as ptosis.
Is it possible to fix the eye itself or only a lift to fix the ptosis?
Thank you for your question!
You stated in your question that have Horner’s syndrome related to a surgical procedure and
that your eye is pushed inwards and you’re asking if you need surgery to push the eye
outward versus surgery to lift the eye.
So your situation really requires a full examination before you get a more complete or comprehensive
question answered.
That point is, it depends on the type of surgery you had that led to the Horner’s syndrome.
If you had some intracranial or neurosurgical procedure and that the eye is pushed in related
to that, then we’re talking about something that has to do with the bones around the eyes
called the boney orbit.
And that reconstruction can be very complex and may require a team approach or an orbital
oculoplastic surgeon, neurosurgeon in order to achieve the restoration and the position
of the eye.
It may or may not be practical to do that.
A lot of times in our practice, and I’m a practicing oculofacial plastic surgeon in
Manhattan and Long Island for over 20 years, in patients who have enophthalmos which means
the eyes pushed in such as for yourself, or exophthalmos where the eye is pushed out,
and that typically in a situation in a condition called grave’s disease or thyroid eye disease,
we always have to think practically.
You know in the real world and people’s lives and you know being able to work, our
goal is to always reduce risk.
A lot of times, eyelid surgery alone is reasonable compromise because trying to achieve ideal
may involve more risk than it is worth.
So a lot of times, let’s say for example, thyroid eye disease patients has eyes that
are bulging out very much and they don’t like it but then one eyelid is particular
high, I would offer the option of just bringing that eyelid down.
That’s not a simple procedure but it is less invasive than doing an orbital decompression.
They may choose to do that and when they see that the eyes are more symmetric, they’re
happy with the results and they don’t feel that they need to do what is the classic approach
in our field in terms of the textbook approach which is first decompress the eye and then
do eyelid surgery.
Again, we have to deal with individual situations and of course, risk and benefit.
So I think in your situation, I think more detail is necessary and you should be brought
to the attention of an oculoplastic or orbital surgeon and if you had neurosurgery as I described,
then it is something that you should also discuss with your neurosurgeon about what
the complexity would be of trying to get back the eye in normal position.
The challenge a lot of times is when the eye recedes back, there’s a lot of scar tissue
that forms and it makes it very difficult even with correction of the structure around
the eye for the eyeball to be moving forward.
So it may still be more practical to have ptosis surgery to get the eyelid in a more
natural symmetric position.
Whenever an individual has a problem like yours or variations, people naturally always
think that everyone’s looking at them and sees that asymmetry as so like it’s glaringly
obvious.
But I always I always tell them that people look at you globally.
And if you are able to create some balance even with one or two millimeters of correction,
then everything else kinds of averages out and blends and sees it as a camouflage.
So moving forward, meet with some doctors and specialties I described so that you can
get more information.
You may need imaging studies.
You may need more to figure out whether or not a more complex surgery in the orbit necessary
versus a more straightforward surgery that we routinely do in our office whether or not
it’s to lift the eyelid or bring the eyelid down, it’s considerably less risky.
So once you have your information, move forward with whatever you’re comfortable with.
So I hope that was helpful, I wish you the best of luck and thank you for your question!