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Hypertelorism refers to an excessive distance between the eyes, exceeding the normal range. This condition often manifests as a clinical symptom and can stem from various causes. It typically occurs during embryonic development when the eye frames fail to converge as they should, potentially leading to underdevelopment in the brain, eyes, or nose.
The severity of hypertelorism is assessed by measuring the distance between the innermost points of the two orbits, usually at the junction of the lacrimal bone and the ethmoid bone, known as the lacrimal puncta. For normal adults, this distance is approximately 25 to 28 millimeters, while for five-year-old children, it ranges from 12 to 15 millimeters. In adults, an eye distance greater than 30 millimeters is considered excessive. This is categorized as:
Individuals with hypertelorism may have an inconsistent appearance, particularly those with third-degree severity, which can be socially challenging. Beyond aesthetic concerns, third-degree hypertelorism often impairs the ability to focus on a single object simultaneously, potentially causing amblyopia, strabismus, and increased facial dissatisfaction.
Excessive eye distance frequently results from premature closure of cranial sutures, orbital protrusion at the forehead-nose junction, or central clefting. It can also develop after trauma, such as orbital fractures or bone tumors. Diagnosis involves photographs, ruler measurements, or advanced imaging like head X-rays and computed tomography to accurately gauge the distance and identify any skeletal abnormalities.
Treatment involves moving the orbits inward and can be tailored based on occlusion:
Intraorbital transfer surgery requires collaboration with a neurosurgeon to protect the brain. The process includes separating orbital bones from surrounding tissues, excising excess central bone, and repositioning the orbits inward for fixation. Bone grafts from the skull are often transplanted around the orbits and nasal bone. Potential complications mirror those of other craniofacial surgeries, such as infection, cerebrospinal fluid leakage, or obstruction of the lacrimal ducts. Surgery is typically performed after age five, though earlier intervention may be considered for psychological, learning, or social adaptation issues.