Asian eye one big one small, is this ptosis, and what can be done?
I am an Asian female teenager.
My one eye is much smaller than the other.
My bigger eye has a much better vision than my smaller eye.
Is this ptosis?
Is there anything that can be done to make my small eye vision better and also both eyes
more the same size and look?
Thanks.
Thank you for your question.
You submitted a photo, and in your question, you described that you’re an Asian teenager,
and that one eye is smaller than the other.
You mentioned in your question that the vision in that eye is not as good as the eye that’s
more open, and you’re asking can you make the vision better, as well as open the eye
more.
So, just to understand the situation, there is some limitation based on a submission of
a single photo, which is taken on an angle.
I’m a cosmetic Oculofacial plastic surgeon, which means that my background training was
first in eye surgery—ophthalmology—then I did specialized training in plastic surgery
of the eyes and face.
I also went further and became Board-certified in full-body cosmetic surgery.
I’m going to give you some details to understand so that you can pursue that best course of
action based on your question.
First of all, if your eyelid is drooping on the left side as it appears in the photo,
and you’ve always had this, then we refer to this condition as “congenital ptosis”.
Ptosis means “drooping” and we’re talking about eyelid ptosis and that you were born
with it (congenital, meaning you were born with it).
When we evaluate congenital ptosis, when a child is under 6 years old, it’s very important
to understand that impact of ptosis on vision.
The reason why I used the number of 6 years old, from age 0 to 6, visual development requires
a clear image in each eye, and if it is impaired, then that eye becomes what’s often referred
to as a “lazy eye”.
A “lazy eye” doesn’t mean that the eyelid is drooping or the eyelid is crossed, but
rather, the vision doesn’t develop fully.
The medical term is “amblyopia”.
So, amblyopia is a permanent decrease in vision due to neurologic development secondary to
a lack of clear image being projected on the retina—on the back of the eye—and it goes
all the way to the brain.
So, when you say the vision isn’t as good as the other eye, it may be amblyopia, but
you have to have a full ophthalmic examination in order to determine whether or not you may
just need glasses, or whether or not you truly have amblyopia.
So, to answer the question about whether or not you can get better vision, it requires
a visit to an ophthalmologist—maybe a pediatric ophthalmologist—to truly evaluate the potential
of vision in that eye.
As far as ptosis is concerned, well, ptosis is correctible.
It is correctible based on several different methods, depending on two major factors.
One is the degree of ptosis, which means how low the eyelid is relative to the center of
the eye called the “pupil”, as well as the muscle function.
There’s a muscle that is called the “levator muscle”—the muscle that is responsible
for lifting the eyelid (it’s like the word “elevator”), and this muscle can have
various levels of strength.
Congenital ptosis basically is a condition where the muscle that lifts the eye—the
levator muscle—doesn’t develop fully.
In other words, this muscle neither contracts fully as a normal muscle does, nor does it
relax fully.
So, based on the degree of muscle function, and the degree of ptosis, we determine what
is the best surgical option.
In our practice, we routinely perform congenital ptosis on adults, and usually in that situation
we actually have our patients cooperate, because there’s a lot of technique and method to
try to get the optimal height, shape and contour.
And in many times, we actually sit our patients up to see if the height and everything looks
right.
It’s a very dynamic procedure, and it depends on your age as well as your level of tolerance
and whether or not you can handle that.
I have operated on patients as young as 14 in this manner, but usually younger than that,
kids find it difficult to cooperate without being too scared.
So, I think that your best option is to meet with an ophthalmologist and get some information
first about your visual potential, and then meet with an Oculoplastic or Oculofacial plastic
surgeon—this is a specialty in ophthalmology, and we deal with ptosis routinely, and it
is a very big part of what an Oculofacial plastic surgeon does.
So I hope that was helpful, I wish you the best of luck.
Thank you for your question.