Surgical Treatment of Proptosis due to High-axial Myopia During Lower Eyelid Blepharoplasty in Identical Twins

Unilateral high-axial myopia can be associated with amblyopia and relative proptosis due to elongation of the eye and staphyloma formation. It is important to consider addressing any relative proptosis at the time of a lower eyelid blepharoplasty as the proptotic eye often creates a significant negative vector and increases the likelihood of postoperative retraction and scleral show. We present twin sisters who presented for a lower eyelid blepharoplasty evaluation; each sister had unilateral proptosis with high-axial myopia. Both underwent bilateral lower eyelid blepharoplasty and unilateral fat decompression in the proptotic eye. One sister required additional medial wall bony decompression to resolve the proptosis at the time of the aforementioned surgery. Therefore, it is important to consider globe position and degree of proptosis at the time of lower eyelid blepharoplasty surgery to optimize surgical results.