Uneven Eyes After Car Accident: Causes and Solutions

Unequal pupil size after a car accident?

Hello, doctor.
Two years ago, I was in a car accident, and at that time, my left eye was constantly closed and I couldn't open it.
Although I can open it now, it is no longer the same size as before, especially when I look up or down, which is very noticeable.
The primary surgeon (a plastic surgeon) believed that even if I had double eyelid surgery, it would not restore the original size.
He planned to use fat grafting to fill the indentation on my forehead (which occurred when my face hit the ground during the accident, causing bone fractures), but due to the short timeframe and the need for another surgery, the procedure was not performed.
Another neurosurgeon advised me to do more eye exercises (lifting), but I still cannot regain the original size.
I am unsure what caused this issue and how to resolve it.

Niming, 20~29 year old female. Ask Date: 2017/05/08

Dr. Zhou Hongzhang reply Plastic Surgery

These issues require a complete medical history assessment, physical examination, and radiological examination.

Reply Date: 2017/05/08

More Info

After a car accident, experiencing uneven eyes or changes in eye appearance can be concerning and may stem from various underlying causes. In your case, it seems that the trauma from the accident has led to significant changes in your left eye, which was initially unable to open and now appears different in size, especially when looking up or down. This situation can arise due to several factors, including muscle damage, nerve injury, or structural changes in the eye and surrounding tissues.

Causes of Uneven Eyes After Trauma
1. Muscle Damage: The eye is controlled by several muscles that allow for movement in different directions. Trauma can lead to damage or scarring of these muscles, resulting in difficulty moving the eye or asymmetry in appearance.

2. Nerve Injury: The facial nerve controls the muscles around the eye, including those responsible for eyelid movement. If the nerve is injured during the accident, it can lead to drooping or inability to fully open the eyelid, contributing to the appearance of uneven eyes.

3. Orbital Fractures: If the bones surrounding the eye (the orbit) were fractured during the accident, this could lead to changes in the position of the eye or the surrounding soft tissues, resulting in asymmetry.

4. Soft Tissue Damage: Injuries to the skin and underlying tissues can lead to scarring or changes in the contour of the eyelids and surrounding areas, affecting the overall appearance of the eyes.

5. Fat Redistribution: Trauma can also lead to changes in fat distribution around the eyes, which can affect how the eyes look, especially if there is a loss of volume in certain areas.

Solutions and Recommendations
1. Consultation with Specialists: Given the complexity of your situation, it is crucial to consult with both an ophthalmologist and a plastic surgeon specializing in ocular and facial reconstruction. They can assess the extent of the damage and recommend appropriate interventions.

2. Surgical Options: Depending on the findings, surgical options may include:
- Reconstructive Surgery: This could involve repairing any muscle or nerve damage, repositioning the eye, or addressing any orbital fractures.

- Fat Grafting or Fillers: If there are volume deficits due to trauma, fat grafting or the use of dermal fillers may help restore symmetry.

3. Eye Exercises: While you mentioned that eye exercises have not yielded results, they can sometimes help improve muscle function and coordination. It may be beneficial to continue these under the guidance of a physical therapist or an ophthalmologist.

4. Follow-Up Care: Regular follow-up appointments with your healthcare providers are essential to monitor your progress and make adjustments to your treatment plan as needed.

5. Psychological Support: Dealing with changes in appearance can be emotionally challenging. Seeking support from a counselor or support group may help you cope with the psychological aspects of recovery.

6. Patience and Time: Healing from trauma can take time, and it is essential to be patient with the recovery process. Changes may continue to occur in the months following the injury.

In summary, the uneven appearance of your eyes post-accident can result from a combination of muscle, nerve, and structural injuries. A multidisciplinary approach involving specialists in ophthalmology and plastic surgery is crucial for determining the best course of action to restore function and appearance. Regular follow-ups and possibly surgical interventions may be necessary to achieve the best outcome.

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