Orbital hypertelorism refers to a wider-than-usual distance between the bony eye sockets. Although the eyes themselves are often healthy, the spacing can influence the overall appearance of the face. This feature is usually noticed in early childhood as facial features become clearer.

Who Can Have Orbital Hypertelorism?

Orbital hypertelorism can appear in different situations. It may be seen on its own or as part of certain genetic conditions, such as:

• Noonan syndrome

• Neurofibromatosis type 1 (NF1)

• Craniofrontonasal dysplasia

It can also result from mechanical developmental factors, such as premature fusion of skull bones (craniosynostosis), which affects how the facial bones grow before birth.

Milder Variations That Do Not Require Treatment

Not every case requires medical intervention. Some people simply have naturally wide-set eyes that fall within the range of normal facial variation. In popular culture, actress Anya Taylor-Joy is often admired for her wide-set eyes, which are considered a characteristic feature of her appearance. This example shows that wider eye spacing can be a normal trait, not always a medical condition.

How Does the Condition Develop?

The difference forms during early fetal development. If the nasal and orbital structures do not move into their usual positions, the eye sockets may form further apart. This process happens before birth and is not caused by anything done during pregnancy.

In one informative Instagram post, a Dr. Sermed Mezher explains orbital hypertelorism and highlights how wider-set eyes may simply reflect normal human variation, rather than always indicating a medical issue.

When Is Treatment Considered?

Surgery is considered when:

• The spacing is significantly increased

• It affects facial balance

• The child may experience social or emotional challenges later in life

Vision is often normal, so the decision is typically based on facial structure and well-being rather than eye function.

Surgical planning is usually done between 5 and 8 years of age, when the bones are strong enough to reshape but still adaptable as the child grows.

How Treatment Is Performed

Treatment takes place in specialized craniofacial centers with multidisciplinary teams.

A common method is craniofacial reconstruction, which reshapes and repositions the orbits. Two approaches described in current practice include:

1. Orbital box osteotomy- Moves the eye sockets closer together

2. Two-stage bone-conserving reconstruction- Used especially in craniofrontonasal dysplasia to preserve bone while repositioning gradually.

Preserving bone is important to maintain stability and support facial growth over time.

Why Awareness Matters

Awareness helps families understand that not every facial difference means something is “wrong.” Recognizing normal variation is equally important as identifying cases that benefit from early evaluation. When needed, timely referral to specialists helps ensure the best outcomes.

References

1. Batut C, Joly A, Travers N, Guichard B, Paré A, Laure B. Surgical treatment of orbital hypertelorism: Historical evolution and development prospects. J Craniomaxillofac Surg. 2019 Nov;47(11):1712-1719. doi: 10.1016/j.jcms.2019.07.002. Epub 2019 Jul 13. PMID: 31519384.

2. Tashima A, Brady C. Orbital Hypertelorism. Clin Plast Surg. 2025 Apr;52(2):209-217. doi: 10.1016/j.cps.2024.10.004. Epub 2024 Nov 7. PMID: 39986883.

3. Paternoster G,Haber S, Britto J, Benderbous D, James S, Legros C, Khonsari R, Arnaud É. Strategy for Bone Conservation in the Two-Stage Correction of Hypertelorism in Craniofrontonasal Dysplasia. Journal of Craniofacial Surgery 31(6):p 1841-1843, September 2020. | DOI: 10.1097/SCS.0000000000006585

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