Orbital Hypertelorism: Surgical Management

The term “ocular hypertelorism” was introduced by Greig in 1924 to describe an abnormally increased distance between the eyes. It originates from the Greek word telouros meaning distant. In 1972, Paul Tessier used the more accurate term “orbital hypertelorism” to denote lateralization of both the medial and lateral walls of the orbital complex [1–4]. Tessier is also credited with performing the first orbital mobilization surgery using an intracranial approach in 1963. The term hypertelorism is reserved for congenital malformations characterized by the widening the nasal root, opening of the ascending processes of the maxilla, and outer displacement of the orbits, the eyes, and the lateral canthi. The deformities that exhibit hypertelorism include midline and paramedian clefts, with or without nasal anomalies; craniosynostoses, particularly craniofrontonasal dysplasia; and hypertelorism associated with Apert syndrome, frontonasal encephaloceles, and midline dermoids [1]. Hypertelorism is a physical finding in many craniofacial anomalies and not a syndrome in itself. Hypertelorism should be differentiated from telecanthus, which is the increase in medial intercanthal distance without a relative displacement of the eyes or orbits in relation to facial midline. This may appear with fracture involving the naso-orbital-ethmoid complex that produces detachment of the medial canthal tendon.