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Houston Cranio Facial

Orbital Hypertelorism

A physical sign of a problem rather than a condition or syndrome, orbital hypertelorism describes orbits (eye “sockets”) that sit far apart on the face. The distance between the eyes can be mild, moderate, or severe, and, in certain circumstances, the separation may continue to increase as the child grows. Hypertelorism on its own should not affect vision or intelligence; however, other symptoms will vary depending on the associated cause. In many cases, the primary concern will be preventing social consequences, such as teasing, and the negative self-image that can result from having hypertelorism. Our extensively trained plastic and craniofacial surgeon, Dr. Eric Payne, and his skilled medical team emphasize a compassionate, patient-focused approach. Using state-of-the-art equipment with the latest technology, allows us to accurately diagnose and effectively treat orbital hypertelorism.

It’s important to note, facial asymmetries, which are highly common and perfectly normal, sometimes can be mistaken for orbital hypertelorism by parents. Furthermore, hypertelorism is distinct from telecanthus, in which the space between the orbits is normal but the iris and pupil (colored parts of the eye) sit too closely to where the inner eyelids meet (medial canthus). Both of these physical signs also can occur simultaneously (wide-set orbits and eyes set too close). Our extensively trained medical team can evaluate your child’s anatomic indicators and inform you of the best course of action, if any will be needed. Contact us today to learn more or to schedule a consultation.

What is orbital hypertelorism?

In orbital hypertelorism, the eye sockets are spaced widely apart while the eyes (iris and pupil) remain centered in the orbit. As an embryo develops, the orbital bones start far apart, near the sides of the head, and gradually move closer together. A number of issues, including a facial cleft, a tumor growth, premature fusion of the skull bones, or another concern can disrupt this process. In some cases, distortions of the skull and facial structures in early childhood development can lead to orbital hypertelorism. It’s important to determine the underlying cause of hypertelorism to provide optimal treatment not only for wide eyes but also for any additional factors that could affect the child’s health, function, and appearance.

How does this hypertelorism occur?

Orbital hypertelorism is associated with a number of conditions, including but not limited to craniosynostosis, Apert syndrome, frontonasal dysplasia, and encephaloceles. Determining the underlying cause is essential to creating a customized treatment plan. Genetic testing, CT scans, MRIs, and other tests may be utilized to arrive at the final diagnosis. Only by finding the origin of the hypertelorism can Dr. Payne properly address all contributing factors and help to achieve the best longest-lasting outcome.

Can orbital hypertelorism be passed on through the family?

Since orbital hypertelorism is typically a physical sign or feature of a condition, its heritability will depend on whether the condition can be transmitted genetically. In many associated syndromes there can be a family history of the disorder; however, they often can also occur spontaneously. Genetic testing and other diagnostic tools will help Dr. Payne determine if your child was predisposed to develop orbital hypertelorism or its underlying cause, and whether there may be a risk of him or her passing it to their children in the future. Typically consultation with a medical geneticist is done to guide you and your family in determining a potential genetic cause of hypertelorism if indicated.

What are the signs and symptoms of orbital hypertelorism?

There are a few variations that may occur in the development of orbital hypertelorism. In general, the condition that causes the signs will influence the symmetry and severity of the hypertelorism. It’s not unusual for one orbit to be positioned in a relatively central location while the other orbit is placed further out. Additionally, one or both orbits may be situated higher or lower on the face than is typical. Telecanthus may also be present, although this is a separate physical sign and not specifically associated with orbital hypertelorism.

What are the treatment options?

There are a number of techniques that can close the distance between the orbits and improve the appearance of wide eyes. Box osteotomy and facial bipartition (also known as median faciotomy) are two of the most common. Bone grafts may be used, as well as orbital rim implants, to achieve a more regular facial shape and proportion. Dr. Payne and his team will determine the ideal approach based on the severity of the signs and the underlying condition or cause of the hypertelorism. Every treatment is customized to provide results that factor in function and aesthetics, as well as your child’s long-term well-being.

Most children with hypertelorism will be treated between the ages of five to eight years old. By this age range, a child’s facial structures should have developed to the point that surgery presents a lesser risk of complications. Additionally, this tends to be the time when children may begin to experience unwanted attention from schoolmates and bullying. Dr. Payne works with a pediatric ophthalmologist on cases of hypertelorism to ensure the vision and structure of the eyes are optimal.

What is the recovery process like?

Each treatment plan will be tailored to provide the optimal outcome for each child’s individual needs. As a result, the recovery experience will differ depending on the techniques used, the age of the patient, the severity of the condition, and the unique healing rate of the patient. You can find additional information on the procedures utilized and typical recovery process of many craniofacial conditions and facial and skull deformities on our site. Our skilled medical team is also happy to answer questions over the phone. Some children may require a secondary surgery later in life to further correct hypertelorism and improve the outcome after the facial structures have reached skeletal maturity.

We understand diagnosis and treatment of orbital hypertelorism can be an emotional experience, and we’re here to provide information and support. If you have questions, or if you would like to schedule a consultation, please contact our practice today.