Medical Oncologist
CION Cancer Clinics
Eye position and vision after a maxillectomy | CION Cancer Clinics
The top of the upper jaw is the floor of the eye socket, so a maxillectomy that reaches that high can leave the eye sitting lower, seeing double or watering. Most maxillectomies do not reach the eye. When they do, most of these problems can be improved. This page explains why they happen, what settles on its own, how each is treated, and the one sign that is an emergency. CION Cancer Clinics’ surgical oncologists in Hyderabad can talk this through with you.
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Medically reviewed by Dr. Muralidhar MuddusettyConsultant Surgical Oncologist · MBBS (AIIMS), MS (Surgery, AIIMS), DNB (Surgical Oncology), MRCS (Edinburgh) · last reviewed September 2026, next review due September 2027
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On this page
- Why can a maxillectomy affect the eye?
- The four eye problems that can follow, and what helps
- What the team does about eye problems, in order
- Four things families say about the eye, and what is true
- What can and cannot be put right, and what this page cannot tell you
- Common questions about the eye after maxillectomy
The short answer
Why can a maxillectomy affect the eye?
The roof of the upper jaw is the floor of the eye socket. When the upper part of the maxilla has to be removed for cancer, the eye can lose the shelf it rests on. Most maxillectomies do not reach that high and the eye is not affected. When they do, the common problems are double vision, an eye that sits lower or further back, and a watering eye. Most can be improved.
What the maxilla does for the eye
The maxilla is the upper jaw bone. It holds the upper teeth, forms the roof of the mouth, and its top surface is a thin plate of bone that the eyeball and its fat sit on. The tube that drains tears from the eye into the nose also runs through it. Remove the top of the bone and the eye can sink, the muscles that move it can be pulled out of line, and tears can lose their drain.
Whether your operation reaches that high
Your surgeon knows from the scan whether the floor of the eye socket will be removed, left alone, or removed and rebuilt at the same time. Ask directly. If the floor is rebuilt with bone, a mesh or a flap during the same operation, many of the problems on this page are prevented rather than treated.
This page is about an eye that is kept. When the eye itself has to be removed with the maxilla, a separate page in this section covers that.
!
One thing that cannot wait
Sudden loss of vision in the eye on the operated side, an eye that is bulging forward or rock hard, or severe pain behind the eye, can mean bleeding or pressure building inside the socket. Go to the nearest emergency department the same hour, not the same day, and say you have had upper jaw surgery. Do not press on the eye, and do not lie flat and wait to see if it settles.
Not sure whether this applies to you?
Ask an oncologistWhat you may notice
The four eye problems that can follow, and what helps
Swelling in the first weeks causes some of these on its own. The ones that remain once swelling has gone are the ones the team plans for.
Double vision
Seeing two of everything, worst when looking up or to the side. It happens because the eye has dropped or a muscle is caught, so the two eyes no longer point the same way.
What helps
- Covering one eye while swelling settles
- Prism glasses, or a small operation if it persists
An eye that sits lower or further back
Without its floor the eyeball drops and sinks. The eye looks smaller and the upper lid may hang. If the floor was rebuilt during surgery this is usually mild. If not, it can be rebuilt later.
A watering eye
The tear duct runs through the maxilla and is often cut. Tears then spill down the cheek instead of draining into the nose. Some ducts reopen on their own. Persistent watering is treated with a small operation to make a new drain.
A lower lid that droops or turns out
Scarring from a cut under the eye, or loss of support, can pull the lower lid down. The eye then looks red and feels gritty. A tightening procedure once things have settled usually corrects it.
Lubricating drops in the meantime keep the surface of the eye comfortable.How it is handled
What the team does about eye problems, in order
Checks before surgery
If the scan shows the eye socket floor may be involved, your vision, eye movements and eye position are recorded beforehand, and an eye specialist may see you. This gives a baseline to compare against afterwards.
Rebuilding the floor during the operation
Where the floor has to go, many surgeons rebuild it in the same operation with a piece of bone, a thin mesh or a flap of tissue. Ask whether this is planned for you and what would be used.
Watching and waiting through the swelling
In the first weeks, swelling alone can cause double vision and a displaced eye. The team checks vision daily in hospital and at each review, and holds off on decisions until the swelling has gone.
Eye specialist review
Problems that persist are sent to an ophthalmologist, an eye doctor. Prism glasses, a small operation on an eye muscle, a new tear drain or lid tightening are the usual options, planned once the cancer treatment is complete.
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Commonly believed
Four things families say about the eye, and what is true
"Double vision after surgery means the eye is damaged."
In the first weeks it usually means the eye has been pushed out of line by swelling, not that the eye itself is hurt. The eyeball and the nerve to it are not part of what is removed. Double vision that remains after swelling has gone is about position and muscles, and it can be treated.
"Every maxillectomy affects the eye."
Most do not. Only operations that remove the top of the maxilla, where it forms the eye socket floor, put the eye at risk. Your surgeon can tell from the scan which kind yours is. Ask before the operation rather than worrying afterwards.
"If the eye is watering, it must be infected."
A watering eye after this operation is usually a drainage problem, because the tear duct runs through the removed bone. Infection causes redness, pain and sticky discharge as well. Plain watering with a comfortable eye is a plumbing problem, and it can be fixed.
"Nothing can be done about a sunken eye."
The floor of the socket can be rebuilt after the event as well as during the operation, and the eye lifted back into position. It is usually planned once the team is confident about the cancer and the tissues have settled. Ask what would be possible in your case.
Being straight with you
What can and cannot be put right, and what this page cannot tell you
Position, drainage and lid problems can usually be improved. What cannot be undone is any loss of vision that comes from the cancer itself having grown into the socket, or from the rare bleed or pressure problem in the first days that is not treated in time. That is why the warning box on this page matters more than anything else on it.
Radiotherapy and the eye
If radiotherapy follows and the eye is close to the treated area, it can dry the eye, cloud the lens over time, and in some cases affect the back of the eye. The radiotherapy team shapes the beams to spare the eye where they can, and will tell you plainly what the risk is for your own plan. Lubricating drops and regular eye checks are part of follow-up.
What this page cannot tell you
It cannot tell you whether your own operation will reach the eye socket floor, or whether double vision in the first week will settle or need treating. Those answers come from your scan and from the eye checks after surgery. Ask your surgeon to point out, on the scan, how close the cancer is to the floor of the socket, and whether it will be rebuilt.
Bring your glasses prescription and any history of eye disease to the first appointment. It changes the planning.Questions we are asked
Common questions about the eye after maxillectomy
Will my double vision go away?
Double vision caused by swelling usually settles over the first weeks. Double vision that remains after that is caused by the eye sitting lower or a muscle being caught, and it is treated with prism glasses or a small operation. Covering one eye in the meantime makes daily life easier and does no harm.
Can I drive with double vision?
No. Driving with double vision is unsafe for you and for others, and it is not permitted. Wait until the eye specialist confirms your vision is single again, with or without prism glasses. Ask them directly, and get the answer in writing if your licence or your work depends on it.
Why is my eye watering all the time?
The tear duct that drains tears into the nose runs through the maxilla and is often cut. Tears then overflow onto the cheek. Some ducts reopen on their own over the following months. If watering persists and the eye is otherwise comfortable, a small operation to make a new drain usually fixes it.
My eye looks smaller and lower than the other. Is that permanent?
Not necessarily. Some of it is swelling and lid droop, which settle. What remains is the eye sitting lower because its floor is gone. That floor can be rebuilt, either during the original operation or later, and the eye lifted. Ask your surgeon what was done and what could be done next.
Do I need to see an eye doctor as well as the surgeon?
If the eye socket floor was involved, yes, and your surgical team will usually arrange it. An ophthalmologist checks vision, eye movements and the surface of the eye, and plans any prism, muscle, lid or tear duct treatment. If you have not been referred and have symptoms, ask.
Will radiotherapy damage my eye?
It can affect it if the eye is close to the treated area. Dryness is common, clouding of the lens can develop over years, and the back of the eye is at risk with higher doses. The radiotherapy team shapes the treatment to spare the eye where possible and will tell you the risk for your own plan.
Can I wear my old glasses or contact lenses?
Glasses, yes, though the frame may rest awkwardly on a swollen or numb cheek at first. Contact lenses should wait until the eye specialist says the surface of the eye and the lids are healthy, because a drooping lid or a dry eye makes them uncomfortable and risky.
What should we watch for at home in the first week?
Any sudden worsening of vision, an eye that is bulging or very hard, severe pain behind the eye, or a lid that cannot close over the eye. These need same-day emergency care. Gradual swelling, bruising and mild blurring are expected. If you are not sure which you are looking at, call the helpline.
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Medical Oncologist
Dr. C. Raghavendra Reddy
MBBS(Gold Medal), DNB(General Medicine), DM(Medical Oncology)(Gold Medal)
Medical Oncologist
Dr. Bharati Devi Gorantla
MBBS, MD(General Medicine), DM(Medical Oncology)(Adyar,Chennai), ECMO, MRCP SCE(UK)
Medical Oncologist
Dr. Owais Mohammed
MBBS, MD (General Medicine), DrNB (Medical Oncology), ECMO, MRCP SCE (Medical Oncology) (UK)
Medical Oncologist
Medical Oncologist
Surgical Oncologist
Dr. Muralidhar Muddusetty
MBBS (AIIMS), MS (Surgery) (AIIMS), DNB (Surgical Oncology), MRCS (Edinburgh)
Surgical Oncologist
Surgical Oncologist
Surgical Oncologist
Dr. Vinay Mamidala
MBBS, MS(General Surgery), M.Ch(Surgical Oncology), FMAS, FARIS(Ongoing)
Surgical Oncologist
Radiation Oncologist
Radiation Oncologist
Radiation Oncologist
Hematologist
Surgical Oncologist
Dr. Vajja Sandeep Kumar
MBBS, MS (General Surgery), DrNB (Surgical Oncology), FALS Oncology
Surgical Oncologist
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Sources
- NHS — Double vision
- American Cancer Society — Surgery for Nasal Cavity and Paranasal Sinus Cancer
- National Cancer Institute — Paranasal Sinus and Nasal Cavity Cancer Treatment (PDQ) - Patient Version
- Cancer Research UK — Nasal and paranasal sinus cancer
This page is general information, not a prescription. Do not change or stop any treatment based on what you read here. If anything is worrying you, contact your own treating team — or call our helpline and we will help you reach the right specialist.
Keep reading
Related pages
When the Eye Has to Be Removed With the MaxillaThe separate situation where the eye cannot be keptPartial, Total and Extended MaxillectomyWhich types reach the eye socket floorFacial Appearance and Cheek Support After MaxillectomyThe cheek and lid changes that go with a dropped eyeComplications and Red FlagsThe signs after any operation that need a same-day callRadiation therapy guideIf radiotherapy near the eye is part of your plan
Talk to us
Worried about your eye after jaw surgery?
Send us your scan or call the helpline. A surgical oncologist can tell you whether the eye socket floor is involved in your case and what would be done about it. One helpline serves every CION centre.