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Orbital hypertelorism

What is orbital hypertelorism?

Orbital hypertelorism (OR-bit-ul hi-per-TELL-uh-riz-um) is an abnormally wide distance between the eyes. Orbits are the openings in the skull where the eyes are located. When these openings in the skull are unusually far apart, the eyes are also too far apart. It is a rare condition that is present at birth, affecting between 1 in 20,000 to 100,000 babies.

How is it diagnosed?

Doctors usually see the condition when a baby is born. Sometimes, it is found during ultrasound testing before the baby is born.

If doctors think a child has orbital hypertelorism, they will confirm that diagnosis by taking measurements between three specific points on each eye.

The three points that are measured are called:

• Intercanthal distance (ICD): the distance between the inner corners of the eye (closest to the nose)
• Interpupillary distance (IPD): the distance between the pupils of the eyes
• Outer canthal distance (OCD): the distance between the outer corners of the eyes (closest to the ears)

There is a range of distances between these three points that are considered normal. If all three measurements go outside the normal range, then orbital hypertelorism is diagnosed. Doctors will also often perform CT scans to see the skull itself.

Orbital hypertelorism has different degrees of severity based on how far apart the eyes are, a measure called the inter-orbital distance (IOD). This distance is measured between two bones of the eye called the anterior lacrimal crest (an-tear-ee-or LACK-ruh-muhl KREST). These bones are located just inside the eye socket close to the nose. Normal IOD is usually around 30 mm but can vary based on a variety of factors. For people with orbital hypertelorism, the severity can be considered:

• Mild: 30-34 mm
• Moderate: 34-40 mm
• Severe: more than 40mm

There are two conditions that can look like orbital hypertelorism, but do not include the abnormal position of the orbit in the skull:

• Pseudohypertelorism. (soo-doh-hiper-TELL-uh-riz-um) In this condition, the eyes may appear to be abnormally far apart because of how the face is shaped. The person may have a very flat nose, narrow eyes and widely shaped eyebrows.
• Telecanthus: (tell-eh-CAN-thus) In this condition, one of the three measurements used to diagnose hypertelorism, the intercanthal distance (ICD) is abnormal, but the other two distances are normal. This eye shape is often found in children with Down syndrome and other genetic conditions.

Neither of these conditions require surgery.

What causes orbital hypertelorism?

Almost always, orbital hypertelorism develops in the womb as part of a group of abnormalities that happen at the same time in different places in the body. This group of abnormalities, called a syndrome, is present at birth. If a baby is born with orbital hypertelorism, doctors will check many other parts of the body for more abnormalities. Testing could include CT scans, MRIs, heart tests, genetic tests and kidney ultrasounds.

There are many different syndromes that may include orbital hypertelorism. Some are Apert, Crouzon, trisomy 18 and others that cause changes in the bones of the head. Depending on what syndrome causes the orbital hypertelorism, a baby may also have other facial differences, such as a small jaw, low-set ears, a very flat or very prominent nose or a bony ridge in the middle of the forehead.

In very rare cases, orbital hypertelorism can happen when mucus-filled cysts develop in the sinuses. Nasal cysts can form when something blocks mucus from draining out of the sinuses. If the cysts grow very large, they can weaken or destroy bones near the eyes and nose, and those bones may gradually drift apart. This can affect the position of the eyes.

How is orbital hypertelorism treated?

Surgery can be done to move the eyes closer together. This is a complicated surgery that should be done in hospitals where there are many specialists who can work together to get the best results.

These specialists should include pediatric craniofacial surgeons, who are experts in surgeries of the face and skull; pediatric neurosurgeons, experts in the brain and spine; and pediatric ophthalmologists, experts in the eyes. Children’s of Mississippi has all these specialists plus genetic experts and therapists who also help in the care of children who need this surgery.

There are three main types of surgery to correct orbital hypertelorism:

• box osteotomy
• facial bipartition
• monobloc advancement

Surgery is usually done when a child is between 5 and 8 years old. This gives time for facial bones and teeth to develop enough so that the surgery will not interfere with normal growth. The surgeons will use the technique best suited to the child’s specific condition. Depending on the severity of the condition, a child might need to have more than one surgery to complete all the treatment needed.

At Children’s of Mississippi, your child’s physician will discuss the details of the surgery with you. Our team will make sure you understand what to expect during surgery and afterwards during recovery in the hospital and back home.

Children who have orbital hypertelorism as part of a syndrome may need additional surgeries and other types of care to treat abnormalities in other areas of the body.

What is the outlook for orbital hypertelorism?

The outlook for children with orbital hypertelorism depends on what caused the condition. Your team at Children’s of Mississippi has the specialists and expertise to help you and your child manage any physical, psychological and social issues that may happen.

Get help at Children’s of Mississippi

If you are concerned about anything related to the shape or features on your child’s face, you can schedule a consultation with pediatric plastic surgeons at Children’s of Mississippi. They can assess your child, address your concerns and help you understand your options. Schedule an appointment online.

Last reviewed: November 25, 2025