Two Eyes, Two Sizes
Have a look at this news photo -- or just about any posed portrait of him you can find. Then take a gander at my head shot.
Notice how we each have one eye that's bigger than the other? (In my case, way bigger?)
My eyes have been mismatched all my life; I never think about it until I see a photo of myself in which the effect is especially pronounced. But when I noticed that the Republican presidential candidate seems to be similarly out of balance, I wanted to learn more. Is this a common phenomenon? And should I be worried? (Or, as one of my clever Post colleagues wondered in an e-mail, what if one eye is smaller than the other?)
Before I go one step further, let me be clear: I am not commenting or speculating in any way on Sen. McCain's health or well-being or what his multi-sized eyes might say about him as a person or as a candidate. Got that? And, from what I can tell, Democrat candidate Sen. Barack Obama's eyes seem pretty much even-Steven in size.
The folks at the American Academy of Ophthalmology (a word I'm proud to have learned to spell) put me in touch with some eye-care professionals who shed light on this condition. Andrew Prince, a Manhattan ophthalmologist, says he frequently sees patients with one eye that at least appears larger than the other.
"Often it's an illusion," Prince explains, that occurs "when the lid, more often the upper lid, is drooping. The asymmetric appearance can make patients think 'My eye is shrinking' or 'My eye is bulging.'" (The word for a bulging eyeball, Prince tells me, is "protoptosis.")
Uneven eye size can be congenital -- something you're born with -- or it can be related to surgery, injury or certain eye diseases, Prince says. "The most common cause is age," he adds, noting that eyelid drooping (ptosis) often happens as we grow older.
And then there was this comment from Jane Kivlin, a pediatric ophthalmologist and professor of ophthalmology at the Medical College of Wisconsin:
A true difference in horizontal diameter of the iris and cornea is very rare and would most likely be due to elevated pressure in the larger eye prior to age 2 years when the cornea stops growing in size. Most often this is due to ongoing glaucoma, but some congenital glaucoma can resolve spontaneously. Many lay people refer to a different size of eye when actually it is that the lids are in a different position so more of the eye is covered. Usually this is upper lid ptosis but sometimes the lower lid will be higher making the eye look small, or lower, making it look larger. Looking at some pictures of McCain on his Web site, it looks like his left lid fissure is slightly smaller than his right, but it is not pathologic. He has overhanging skin in his upper lids, which is a common aging phenomenon.
So if your eyes suddenly seem disproportionate in size to one another, or if you're at all concerned about your out-of-kilter countenance, an ophthalmologist can help you sort things out -- and to rule out pathology, or disease.
Thyroid disease (including Grave's disease) can cause retraction of the eyelid, making the eye look like it's bulging, or cause the eye to actually bulge, Prince says. Many forms of thyroid disease can be treated once diagnosed.
In very rare instances, a tumor in the eye's orbit can press the eyeball forward and make that eye appear larger, Prince says. (He expressed reluctance to even mention this, as it is indeed rare, and he didn't want readers to panic. So, please, readers, don't panic.)
Since my eyes have always been out of whack, I am most assuredly not panicking. In fact, I have come to embrace my imbalance just one more endearing aspect of who I am.
How about you? Are your eyes of two sizes? Does that bother you?
And have any of you been diagnosed with thyroid disease after noticing a discrepancy in the size of your eyes?
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