Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2020 Dec 31;46(6):379-384.
doi: 10.5125/jkaoms.2020.46.6.379.

Diagnostic analysis of vertical orbital dystopia and canthal tilt for surgical correction

Ju-Young Lee  1   2 , Han-Wool Choung  3 , Pill-Hoon Choung  2
Affiliations

Diagnostic analysis of vertical orbital dystopia and canthal tilt for surgical correction

Ju-Young Lee et al. J Korean Assoc Oral Maxillofac Surg. .

Abstract

Objectives: We sought to identify a clinically useful method of analyzing orbital dystopia to aid in diagnosis and treatment planning and to quantify vertical discrepancies in eye level and variations in canthal tilt in Koreans.

Patients and methods: In 76 Korean patients with a mean age of 23.12 years, mean differences in the level of the pupils, lateral canthi, medial canthi, and canthal tilt were measured. The difference in pupil level was calculated from the perpendicular lines drawn from the midpupil area of each eye to the midline of the face to determine the amount of skeletal discrepancy of the eye. Soft tissue discrepancies were determined according to the vertical difference between the lines drawn from the lateral or medial canthus of each eye perpendicular to the midline of the face. The canthal tilt was determined from the inclination of a line connecting the lateral and medial canthi, then classified as class I, II, or III.

Results: Mean differences in pupil level, medial canthi, and lateral canthi were 1.57±1.10 mm, 1.14±1.07 mm, and 2.03±1.64 mm, respectively. The mean degree of canthal tilt were 8.45°±3.53° for the right side and 8.42°±3.81° for the left side. No study participants presented with class III canthal tilt. The mean canthal tilt values for those with class I tilt were 3.21°±1.68° for the right side and 3.18°±1.63° for the left side, while, for those who had class II tilt, the values were 9.60°±3.66° for the right side and 9.54°±2.99° for the left side.

Conclusion: The presented diagnostic method of orbital dystopia can be used to effectively establish a treatment plan that takes into consideration the patient's skeletal and soft-tissue discrepancies.

Keywords: Anthropometry; Facial asymmetry; Orbit.

PubMed Disclaimer

Conflict of interest statement

Conflict of Interest

No potential conflict of interest relevant to this article was reported.

Figures

Fig. 1
Fig. 1
Analysis of skeletal vertical discrepancy using the differences in the levels of orbits. A horizontal line (white line) from midpupil perpendicular to the midline of the face (black line) was drawn, and the differences between the horizontal lines from each side of the eyes were calculated.
Fig. 2
Fig. 2
Analysis of soft tissue discrepancy using the differences in the levels of medial canthi. A horizontal line (white line) from medial canthus perpendicular to the midline of the face (black line) was drawn, and the differences between the horizontal lines from each side of the eyes were calculated.
Fig. 3
Fig. 3
Analysis of soft tissue discrepancy using the differences in the levels of lateral canthi. A horizontal line (white line) from lateral canthus perpendicular to the midline of the face (black line) was drawn, and the differences between the horizontal lines from each side of the eyes were calculated.
Fig. 4
Fig. 4
Measurement of canthal tilt using an angle formed by a line connecting the medial canthus and lateral canthus (red line) and a perpendicular line (white line) connecting the medial canthus and the midline of the face (black line).
Fig. 5
Fig. 5
Classification of canthal tilt. Criteria for classifying the various canthal tilts was applied. Class I, canthal tilt between 0° and 5°; Class II, canthal tilt over 5°; Class III, canthal tilt less than 0°.
See this image and copyright information in PMC

Similar articles

  • Anatomy of the lateral canthal tendon.
    Rosenstein T, Talebzadeh N, Pogrel MA. Rosenstein T, et al. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2000 Jan;89(1):24-8. doi: 10.1016/s1079-2104(00)80009-8. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2000. PMID: 10630937
  • Ocular adnexal asymmetry in models: a magazine photograph analysis.
    Ing E, Safarpour A, Ing T, Ing S. Ing E, et al. Can J Ophthalmol. 2006 Apr;41(2):175-82. doi: 10.1139/I06-005. Can J Ophthalmol. 2006. PMID: 16767204
  • Is medial canthal tilt a powerful cue for facial attractiveness?
    Bashour M, Geist C. Bashour M, et al. Ophthalmic Plast Reconstr Surg. 2007 Jan-Feb;23(1):52-6. doi: 10.1097/IOP.0b013e31802dd7dc. Ophthalmic Plast Reconstr Surg. 2007. PMID: 17237692
  • Lateral canthal anatomy: a review.
    Kang H, Takahashi Y, Ichinose A, Nakano T, Asamoto K, Ikeda H, Iwaki M, Kakizaki H. Kang H, et al. Orbit. 2012 Aug;31(4):279-85. doi: 10.3109/01676830.2012.694957. Epub 2012 Jun 12. Orbit. 2012. PMID: 22690873 Review.
  • Lateral canthal surgery.
    Chong KK, Goldberg RA. Chong KK, et al. Facial Plast Surg. 2010 Aug;26(3):193-200. doi: 10.1055/s-0030-1254329. Epub 2010 Jun 3. Facial Plast Surg. 2010. PMID: 20524167 Review.
See all similar articles

Cited by

References

    1. Choi KY. Analysis of facial asymmetry. Arch Craniofac Surg. 2015;16:1–10. doi: 10.7181/acfs.2015.16.1.1. https://doi.org/10.7181/acfs.2015.16.1.1 . - DOI - PMC - PubMed
    1. Song WC, Koh KS, Kim SH, Hu KS, Kim HJ, Park JC, et al. Horizontal angular asymmetry of the face in Korean young adults with reference to the eye and mouth. J Oral Maxillofac Surg. 2007;65:2164–8. doi: 10.1016/j.joms.2006.11.018. https://doi.org/10.1016/j.joms.2006.11.018 . - DOI - PubMed
    1. Hwang HS, Youn IS, Lee KH, Lim HJ. Classification of facial asymmetry by cluster analysis. Am J Orthod Dentofacial Orthop. 2007;132:279.e1–6. doi: 10.1016/j.ajodo.2007.01.017. https://doi.org/10.1016/j.ajodo.2007.01.017 . - DOI - PubMed
    1. Altug-Atac AT, Grayson BH, McCarthy JG. Comparison of skeletal and soft-tissue changes following unilateral mandibular distraction osteogenesis. Plast Reconstr Surg. 2008;121:1751–9. doi: 10.1097/PRS.0b013e31816aa003. https://doi.org/10.1097/PRS.0b013e31816aa003 . - DOI - PubMed
    1. Yamashita Y, Nakamura Y, Shimada T, Nomura Y, Hirashita A. Asymmetry of the lips of orthognathic surgery patients. Am J Orthod Dentofacial Orthop. 2009;136:559–63. doi: 10.1016/j.ajodo.2007.10.057. https://doi.org/10.1016/j.ajodo.2007.10.057 . - DOI - PubMed