Vertical orbital dystopia occurs in facial clefts when the orbital floor and/or the maxilla is involved. This means that the eyes are not on the same horizontal line on the face (one eye is positioned lower than the other). Instead of a craniofacial syndrome, vertical orbital dystopia is an exam finding in which the orbits are not level with one another and may be a feature of many of the hemifacial microsomias.
Treatment is based on the reconstruction of the orbital floor, by either closing the bony cleft or reconstructing the orbital floor using bone grafts. In mild cases bone grafts are placed into the orbit may be sufficient to improve the appearance, however, in more extreme cases, the eye sockets may need to be re-positioned with a combined procedure with a neurosurgeon in order to get the best result.