Surgical rehabilitation of orbital dystopia can be challenging. The authors demonstrate the effective use of spectacle
lenses to visually correct misalignments of the globe and the orbit. Presented is a retrospective review of 4 patients undergoing aesthetic rehabilitation through use of spectacle
lenses and in a number patients a cosmetic shell.Two patients with
neurofibromatosis presented with inferior dystopia of the globe and orbit. A base-down prismatic lens applied to the
spectacles in conjunction with a prosthetic shell successfully visually corrected the
facial asymmetry and improved patients' aesthetic appearance. One patient with a history of traumatic
retinal detachment, who did not want any surgical intervention, a "plus" (hypermetropic) lens was used to magnify the perceived image of an enophthalmic and phthisical globe, to enhance appearance and improve symmetry. In the fourth patient, with
Goldenhar syndrome, the appearance of a hypotropia and concurrent
esotropia was successfully treated with a Fresnel prism and a prosthetic shell.This case series illustrates the successful role of various refractive
lenses often in conjunction with prosthetic shells in patients with
reduced vision and orbital dystopia to improve facial symmetry. This
conservative treatment is especially useful when surgery is not a desired or not considered a suitable option for the patient.