Theories include too early ossification of the lower wings of the sphenoid, an increased space between the orbita, due to increasing width of the ethmoid sinuses, field defects during the development, a nasal capsule that fails to form, leading to a failure in normal medial orbital migration and also a disturbance in the formation of the cranial base, which can be seen in syndromes like Apert and Crouzon.

Another reason for a correction age of five years or older is that the surgery should be delayed until the tooth buds have grown out low enough into the maxilla, thus preventing damage to them.

[3] For the treatment of hypertelorism there are two main operative options: The box osteotomy and the facial bipartition (also referred to as median fasciotomy).

[6] The surgery starts off by various osteotomies that separate the entire bony part of the orbit from the skull and surrounding facial bones.

[3] The standard procedure (box osteotomy) was modified by Jacques van der Meulen and resulted in the development of the facial bipartition (or median faciotomy).

[9] To create an acceptable aesthetic result in the correction of orbital hypertelorism, it is also important to take soft-tissue reconstruction in consideration.

[3] As with almost every kind of surgery, the main complications in both treatments of hypertelorism include excessive bleeding, risk of infection and CSF leaks and dural fistulas.

Infections and leaks can be prevented by giving perioperative antibiotics and identifying and closing of any dural tears.