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Dr. Andrew Rynne
MD
Dr. Andrew Rynne

Family Physician

Exp 50 years

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Suggest Treatment For Slight Asymmetry In The Eyes

I m a male, 25 years old. I ve noted a slight asymmetry of my eyes for the past four years. At a first glance, my left eye looks just a tad larger than my right. An eye exam back in 2013 revealed no differential positions of the globes (as in exophthalmos/enophthalmos) but the opthalmologist at the time noted that I had 1mm wider palpebral aperture on my left than right eye but never explained this further. Measurements of globe diameter however revealed that they were equal size. My biggest concern isn t the fact that one eye may (or may not) be set further in or out than the other, but that the eyes do not work simultaneously sometimes when focusing on a certain object. This is most noteable when doing the chin down -posture and looking up. My right eye is seemingly 1-1,5mm above my left eye. It mimicks some strange sort of strabismus, but I am not sure. I ve heard of Brown s syndrome where the affected eye has problem to look up, but I ve also heard of hypertropia where the fixating eye is higher than the normal eye. The problem for me is, no strabismus were ever found during the previous eye exam, nor any malpositions of the globes (exophthalmos/enophthalmos). I was told everything was fine. Something doesn t really add up. I have a CT scan of the orbits done as far back as 2003 (at age 12) and also another cerebral done in 2014 (age 22). I have these pictures, and upon examining them I can not notice any malpositions of the actual orbits or eyeballs that would explain the noted degree of asymmetry. Still, my right eye and left eye doesn t sync all the time. In some pictures taken of me sporadically by friends, I ve noted that I sometime maintain a sloped head posture - even worsening the asymmetry further. It comes natural, but could this be due to that my eyes tries to focus? I also have weird click sounds of my eyes sometimes, which could be just trapped air but I ve read that it is very common in cases of Browns syndrome. But I maintain allmost normal range of motion in every way I look (whereas in Browns Syndrome the affected eye tends to look downwards when looking in) except vertically where the eyes misalign by about 1-1,5mm. I know that this could be just about anything, and no real good answer. But since I ve allready been examined by an opthalmologist who didn t found anything suspicious, what could I do then? The degree of asymmetry is still very noticable in pictures, and I am quite certain that this is something acquired in later years since the asymmetry is not noted in pictures of me when I was younger. Please, hope to hear from you. /worried
Mon, 30 Mar 2020
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General Surgeon 's  Response
Hello,

There are many reasons of the assymetry of the eyes particularly during try to focus on distant object, medial and lateral rectal muscles or superior and inferior oblique ones of different eyes must be working in co relation via medial longitudinal fesciculus. However, there are many of the neurological conditions, particularly that of involvement of cranial nerve III or else, which represent with the assymetry of the eye movements or strabismus in some cases. I would like to recommend a primary eye examination with me by appointment for further discussion in details for possible guidelines of evaluation and outcome aspects.

Hope I have answered your question. Let me know if I can assist you further.

Regards,
Dr. Bhagyesh V. Patel, General Surgeon
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Suggest Treatment For Slight Asymmetry In The Eyes

Hello, There are many reasons of the assymetry of the eyes particularly during try to focus on distant object, medial and lateral rectal muscles or superior and inferior oblique ones of different eyes must be working in co relation via medial longitudinal fesciculus. However, there are many of the neurological conditions, particularly that of involvement of cranial nerve III or else, which represent with the assymetry of the eye movements or strabismus in some cases. I would like to recommend a primary eye examination with me by appointment for further discussion in details for possible guidelines of evaluation and outcome aspects. Hope I have answered your question. Let me know if I can assist you further. Regards, Dr. Bhagyesh V. Patel, General Surgeon