Asymmetrical Eyes

14 sources cited
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What are Asymmetrical Eyes?

Asymmetrical eyes, also called uneven eyes, are when a person's eyes are not the same size, shape, or on the same level. It is common to have facial asymmetry.

With age, skin changes may cause the eyes to look asymmetrical. Typically, asymmetrical eyes are not a medical concern and don’t require treatment. 

Treatment options are available if asymmetrical eyes cause vision problems or become a cosmetic concern.

What Causes Asymmetrical Eyes?

Genetics

Asymmetrical eyes are usually inherited at birth. It may be a common trait among family members and relatives. 

Uneven eyes that run in families are not a medical concern.

Injury 

Trauma to the eye can cause displacement and changes to the space behind it, called enophthalmos. This can lead to asymmetrical eyes. 

Enophthalmos can result in a sinking eye immediately or gradually over time. Symptoms may include:

  • Facial asymmetry
  • Pain
  • Pulling sensation under the eye
  • Double vision 
  • Trouble focusing
  • Dry eye

Medical Condition 

Enophthalmos can also be caused by an underlying medical condition leading to uneven eyes and facial asymmetry. 

Medical conditions that can cause asymmetrical eyes include:

  • Maxillary sinus disease (silent sinus syndrome), a change in sinus fluid pressure 
  • Paget disease (fragile bone tissue)
  • Paranasal sinus tumors, which can lead to bulging eyes
  • Bony defects (lack of bone where it should normally be)

Droopy Eyelid

Droopy eyelids, called ptosis, are caused by a weakening of the muscle that holds up the eyelid. This weakening can lead to uneven eyes.

Common causes of upper eyelid ptosis include:

  • Genetics
  • Aging
  • Neurological conditions
  • Tumors
  • Stroke
  • Eye injury

Proptosis

Proptosis, also called exophthalmos, leads to bulging or protruding eyes. 

Grave’s disease (thyroid condition) is the most common cause of proptosis in adults. Infection, bleeding, or tumors can also cause bulging eyes.

Proptosis symptoms include:

  • A change in your eye’s appearance
  • Bulging eyes
  • Pulsing 
  • Fever (if caused by infection)
  • Vision changes 

Stroke

Facial drooping is a common sign of a stroke (blood supply to the brain is interrupted). A stroke can lead to asymmetrical eyes and an uneven smile.

A stroke is a medical emergency. Other stroke symptoms include:

  • Numbness
  • Confusion
  • Difficulty speaking
  • Severe headaches 
  • Difficulty seeing
  • Trouble walking or balancing 

Bell's Palsy 

Asymmetrical eyes can be caused by Bell's palsy, a temporary paralysis of the muscles on one side of the face, leading to an eyelid that won't close or an uneven smile.

Bell's palsy usually goes away independently, but some symptoms may never resolve. 

Common causes of Bell’s palsy include:

  • Family history of Bell’s palsy
  • Diabetes
  • Weak immune system
  • Reduced blood flow to your face
  • Infection 

How to Fix Asymmetrical Eyes

Facial asymmetry and uneven eyes are common and a natural part of life. 

However, cosmetic treatment options are available for people who wish to fix asymmetrical eyes.

Makeup

Using makeup products (eyebrow pencils, eyeliner, eyeshadow) is a simple way to fix the appearance of uneven eyes. Many online videos are available to guide you on using specific makeup techniques, including:

  • Contouring 
  • Highlighting 
  • Blending
  • Eyelid tape

Makeup professionals working at department or cosmetic stores are also a good resource for teaching makeup techniques.

Botox

Botox, an injectable muscle relaxer, can be a temporary fix for asymmetrical eyebrows. Botox is a non-surgical alternative to a brow lift.

Botox injections are not recommended for people with ptosis (droopy eye), a medical condition that leads to uneven eyes.

Botox injections range from $100 to $4,000, depending on the number of units used. The effects of Botox injections typically last from 3 to 6 months.8 

Brow Lift 

A brow lift is a surgical option to treat asymmetrical eyebrows. A brow lift uses incisions to lift forehead tissue and eyebrows to improve appearance.

There are various types of brow lifts done by cosmetic surgeons, including:

  • Endoscopic brow lifts (small incisions behind the hairline)
  • Coronal brow lifts (small incisions across the top of the head from ear to ear)
  • Hairline brow lifts (small incisions between the top of the forehead and the start of the hairline)

A brow lift usually takes between 1 to 2 hours. Risks include bleeding, infection, and a reaction to anesthesia. The average cost of a brow lift is $3,900.9 

Topical Eye Drops

Upneeq, a prescription topical eye drop, has been approved by the U.S. Food and Drug Administration (FDA) to treat acquired blepharoptosis (droopy eyelids). The eye drops are administered once daily for 6 weeks.10 

Risks of Upneeq include:

  • Dry eye
  • Blurred vision
  • Site pain
  • Eye irritation
  • Headache

Blepharoplasty

Blepharoplasty is an eyelid surgery that removes excess skin from the eyelids. It can be performed on the upper lids, lower lids, or both.

Blepharoplasty is used to treat:

  • Loose or sagging skin
  • Fatty deposits in the eyelid
  • Bags under the eyes
  • Excess skin and fine wrinkles

The average cost of a blepharoplasty is $4,120. Risks of eye surgery include:12

  • Bleeding 
  • Numbness
  • Pain
  • Dry eyes
  • Infection
  • Swelling and bruising

Orbital Surgery

Orbital surgery is surgery of the eye socket and surrounding structures (eyelids, orbital bones, tear duct system, forehead, and mid-face area).

Orbital surgery has been used to fix a variety of eye conditions that can cause asymmetrical eyes, including:

  • Exophthalmos (protruding eyes)
  • Eye injury or illness
  • Ptosis (drooping eyelid)
  • Sagging around the eyes

Risks of orbital surgery include:

  • Blindness
  • Infection 
  • Nerve dysfunction
  • Double vision 

Summary

Asymmetrical or uneven eyes are common and not a cause for concern. Facial asymmetry is usually genetic and does not require treatment.

Medical conditions that can lead to the appearance of asymmetrical eyes include trauma, drooping eyes, thyroid conditions, stroke, and Bell’s palsy. 

Makeup techniques and cosmetic surgery can be used to fix the appearance of uneven eyes. They include Botox, brow lifts, blepharoplasty, eye surgery, and topical eye drops.

14 Cited Research Articles
  1. Wang, T., et al. “Discriminative thresholds in facial asymmetry: a review of the literature.” Aesthetic Surgery Journal, 2017.
  2. Saravanan, A., et al. “Enophthalmos.” StatPearls, 2022.
  3. Shahzad, B., et al. “Ptosis.” StatPearls, 2022.
  4. Topilow, N., et al. “Etiologies of proptosis: A review.” Intern Med Rev, 2020.
  5. American Stroke Association. “Stroke symptoms,” n.d.
  6. Boyd, K. “What is Bell’s palsy?” American Academy of Ophthalmology, 2022.
  7. Boyd, K. “How does Botulinum toxin (Botox) work?” American Academy of Ophthalmology, 2021.
  8. AEDIT. “How much does Botox Cost?” 2021.
  9. American Society of Plastic Surgery. “Brow lift cost,” n.d.
  10. Osmotica Pharmaceuticals. “Osmotica Pharmaceuticals plc Receives FDA Approval for Upneeq™ (oxymetazoline hydrochloride ophthalmic solution), 0.1% for Acquired Blepharoptosis (Droopy Eyelid) in Adults,” 2020.
  11. American Society of Plastic Surgery. “Eyelid surgery: blepharoplasty,” n.d.
  12. American Society of Plastic Surgery. “How much does eyelid surgery cost,” n.d.
  13. UT Southwestern Medical Center. “Oculoplastic and orbital surgery,” n.d.
  14. Jacobs, S., et al. “Incidence, risk factors, and management of blindness after orbital surgery.” 
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