Vertical orbital dystopia--surgical correction.

The surgical correction of vertical malpositions of the human eye has been made relatively safe and reliable by recent surgical techniques. The authors define this condition as vertical orbital dystopia and review the etiology of this deformity in 38 recent consecutive cases that were surgically treated at the Craniofacial Anomalies Center of The University of Virginia. Some new and useful tests are described that are of value to the plastic surgeon in analysis of the facial deformity and in planning the appropriate surgical procedure to correct the vertical dystopia of one or both eyes. Several cases are illustrated that describe the principal surgical methods of moving the eye up or down without loss of vision. The vertical eye shifts in this series have been in the range of 2 to 3 mm to over 22 mm. No loss of vision was produced by these corrections. The most common difficulties and complications of orbital dystopia corrections are described. The implications of this type of surgery in terms of visual physiology are suggested. The authors conclude that surgical correction of vertical orbital dystopias is possible, safe, and rewarding to the patients. However, they advise that the correction is best performed in young children and by a specially trained team of plastic surgeons, neurosurgeons, and ophthalmologists.