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J Forensic Sci. 2024;00:1–14.
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1wileyonlinelibrary.com/journal/jfo
Received: 5 August 2024
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Revised: 12 November 2024
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Accepted: 11 December 2024
DOI: 10.1111/1556-4029.15693
ORIGINAL PAPER
Anthropology
Dimensions and position of the eye for facial approximations in
a South African cone beam computed tomography sample
Soné Van der Walt PhD | Anna C. Oettlé PhD
Anatomy and Histology Department,
School of Medicine, Facult y of Health
Sciences, Sefako Makgatho Health
Sciences University, Ga- Rankuwa,
Gauteng, South Africa
Correspondence
Soné Van der Walt, Anatomy and
Histology Department, School of
Medicine, Sefako Makgatho Health
Sciences University, 232, Medunsa 0204,
Ga- Rankuwa, Gauteng, South Africa.
Email: duplessis.son@gmail.com
Abstract
Accurate population and sex- specific normative values for the orbital and ocular di-
mensions, including the position and protrusion of the eye relative to the orbital rim,
are vital for reliable facial approximations. In studies utilizing cadaveric tissue and
computed tomography scans, the observed measurements may be influenced by des-
iccation, distortion or gravity, respectively. This study assessed the dimensions of the
eye and orbit and established the position and protrusion of the eye relative to the
orbital margin using cone beam computed tomography (CBCT) scans to negate the
effect of gravity in the supine position. Scans of 197 adult South Africans (45 Black
females, 49 Black males, 55 White females, and 48 White males) were selected retro-
spectively from private and public hospitals in Pretoria, South Africa. Linear distances
were calculated from three- dimensional landmarks placed on the orbital rim and ocu-
lar equator using the MeVisLab © v.3.0.2 software. White females presented with
significantly larger orbital heights and axial lengths of the eyes compared to Black
females, while the eyeballs of Black females protruded more from the superior and
lateral orbital margins. Black females presented with significantly smaller dimensions
than Black males. On the contrary, White males exhibited significantly larger protru-
sion values than White females. The results of this study corroborate with the litera-
ture that sex, population, and modality significantly influence the position of the eye
in the orbit, which emphasizes the necessity of creating population- and sex- specific
facial approximations guidelines for the placement of the eye in the orbit.
KEYWORDS
eyeball dimensions, facial approximation, forensic facial reconstruction, ocular position, ocular
protrusion, orbital dimensions
Highlights
• This study used CBCT scans to accurately determine eyeball position and protrusion.
• Ocular position and protrusion are influenced by population affinity, sex, and modality.
• South Africans have more protruding eyeballs compared to other populations.
This is an open access article under the terms of the Creative Commons Attribution License, which permits use, distribution and reproduction in any medium,
provided the original work is properly cited.
© 2024 The Author(s). Journal of Forensic Sciences published by Wiley Periodicals LLC on behalf of American Academy of Forensic Sciences.
Presen ted at the Univer sity Faculty Re search Day, Augus t 23–24, 2022, in P retoria, Sout h Africa; the 49t h Annual Congr ess of the Anatom ical Society of South ern Africa, A pril 19–21,
2022, he ld virtuall y; and at the Inter national BioA ntTalks Conferenc e: Applications of 3D Techn ology to Unide ntified and Mis sing Persons C ases, July 25–29, 2022, he ld virtuall y.
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VAN der WA LT and OETTLÉ
1 | INTRODUCTIO N
The saying, “The eyes are the mirror to the soul” [1], has been inter-
preted in many ways. Still, in the context of facial approximation, this
mirror undeniably assists in facial recognition [2] and is also one of
the first features to consider [3–1 0 ].
In the facial approximation process, a standard- guideline for
eyeball diameter is 25 mm [11, 12]. However, no regard is given to
the possible influence of sex or population affinity [12–14]. In con-
trast, there are many divergent thoughts regarding the placement of
the eye in the orbit. The position of the eyeball in the supero- inferior
and mediolateral planes is sometimes considered to have a central
placement within the orbit [6, 15–17 ], while other researchers have
found that the eyeball is superolaterally located within the orbit
[18–2 2].
Divergent guidelines regarding the placement of the eyes in the
anteroposterior plane or eyeball protrusion, have evolved over the
yea rs [2, 7, 21, 23]. Currently, the guidelines propose that the eyeball
should be positioned in the bony orbit at a depth at which the iris
should touch a tangent taken from the mid superior orbital margin
to the mid inferior orbital margin, without taking sex or population
affinity into consideration [7, 12, 14, 24].
Facial approximations that rely on absolute measurements
based on cadaver studies could be subject to tissue distortion and
shrinkage. On the contrary, as gravity has a different effect in the
supine position than anticipated for facial approximations viewed in
the erect position, measurements derived from scans could be mis-
leading as patients are scanned in the supine position using com-
puter tomography (CT) and magnetic resonance imaging (MRI) [25].
Surprisingly, the literature does not agree on whether gravity signifi-
cantly impacts soft tissue thickness (STT) [26–29]. A set of studies
confine the positional variations to the lateral facial STT landmarks
[25 –2 7, 30]. However, research specifically examining the effect of
gravity on the human eyeball positioning within the bony orbit and
surrounding periorbital structures remains limited and not precisely
quantified [25, 31–34].
The position of the eye in the orbit is also a reflection of the
ocular and orbital dimensions which may vary between geograph-
ically distant groups [7, 22, 35–42]. Orbital shape variations be-
tween population groups may be quantified by determining the
orbital index (OI)—the ratio between the orbital height and the
orbital breadth [35, 38, 40, 41]. The approximate shape of the
orbit may vary from square (OI = 1), rectangular in the horizon-
tal plane (OI <1) to rectangular in the vertical plane (OI >1). Sex
and population group variations in ocular and orbital dimensions
could therefore have important implications for the positioning of
the eyeball and highlight the necessity for population- and sex-
specific guidelines.
Despite these reports that inter- population variation exists [8,
22, 43, 44], guidelines based on other populations are currently
used for facial approximations of South African faces [22]. Studies
that have relevance to the approximation of the eye based on South
African samples are limited. In a pioneering study for the South
African context, variations from the published guidelines included:
a more rectangular orbit resulting in a more transversely elongated
eyeball located superolaterally within the orbit with the exocanthion
situated lower than the endocanthion [22]. Unfortunately, the de-
scription of the methodology and reported dimensions were not
always clear, applicable, and comprehensive and the repeatability
was not satisfactory [22]. The small CBCT sample size of only Black
South Africans further precluded conclusive comparisons between
sexes and population groups.
In this study, we expanded the CBCT scan sample size and in-
corporated two South African population groups. Landmarks for ab-
solute measurements were revised to improve repeatability and to
render it more comparable to other studies. Using CBCT negates the
possible effects that desiccation and distortion may have in the case
of cadavers and avoids the effect that gravity may have on tissues
when in the supine position as noted in CT scanning.
The aim of this study is to determine the dimensions of the eye
and orbit in a South African sample and to establish the position of
the eye in relation to the orbital margin using CBCT scans. Second,
the influence of asymmetry, sexual dimorphism, and population af-
finity on these distances are determined.
2 | MATERIALS AND METHODS
2.1 | Materials
One hundred and ninety- seven retrospectively collected CBCT
scans of adult South Africans without pathological and/or facial
deformities and prior surger y to the midface were assessed. The
CBCT scans were collected from the Oral Health Centre, Sefako
Makgatho Health Sciences University, Oral and Dental Hospital,
University of Pretoria, and from a private institution in Pretoria,
Republic of South Africa. A Planmeca ProMax CBCT 3D scanner
with the following specifications: 90 kV, 8 mA, 11.2 mA, voxel size
of 0.4 mm3, and a maximum field of view of 230 (diameter) mm
by 260 (height) mm was used at the Oral and Dental Hospital,
University of Pretoria and the private institution in Pretoria, while
a Newtom VG i CBCT 3D scanner with the same sp ecifications and
maximum field of view was used at the Oral Health Care Centre,
Sefako Makgatho Health Sciences University. The sample con-
sisted of 45 Black females, 49 Black males, 55 White females, and
48 White males aged between 18 and 87 years. Ethical approval to
conduct the study was obtained from the Human Research Ethics
• Among South African groups, Black females have the smallest ocular and orbital dimensions.
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VAN der WA LT and OETTLÉ
Committee (HREC) of the Faculty of Health Sciences, University
of Pretoria (323/2020).
2.2 | Methods
The DICOM (Digital Imaging and Communications in Medicine)
files were imported into MeVisLab © v.3.0.2 software (available
from h t t p s : / / w w w . m e v i s l a b . d e / ). The MeVisLab software is used
for medical image processing and visualization and is based on
the “Half Maximum Height” quantitative iterative thresholding
method [45]. The segmentation process generates skull and fa-
cial surf ace meshes by separating component s based on their gray
values [45]. As the density of the eyeball is not different enough
from the facial soft tissue structures, and could thus not be re-
constructed accurately in three dimensions (3D), the DICOM files
were used for the placement of ocular landmarks (Table 1). To pre-
vent orientation bias, the original DICOM files were resliced ac-
cording to the Frank for t Horizont al (FH) and sagitt al planes , as per
definition [47], by placing both porions and orbitale landmarks on
the reconstructed skull meshes.
2.3 | Data collection
Landmarks were placed manually on the 3D surface mesh of the
skull and 2D DICOM stack (Table 1, Figures 1 and 2), and the 3D
interlandmark distances (Table 2) were calculated from the landmark
positions using the Pythagorean formula [39]:
Franklin and colleagues have already pointed out in 2005 that
linear measurements derived from traditional anthropometric
measuring techniques, are comparable with linear measurements
derived from three- dimensional landmark coordinates and can be
successfully used in traditional linear dimension studies [48].
The position of the eye relative to the orbital margin was deter-
mined in two different ways so as to (1) maximize its comparison
with the literature and (2) its usability for facial approximations. The
position of the equator of the eyeball in relation to the orbital margin
can be used to measure the depth of the placement of the eye within
Distance
(a−b)=
√(
x
a
−x
b)
2+
(
y
a
−y
b)
2+
(
z
a
−z
b)
2
.
TABLE 1 Definition and dispersion (intra- and interobserver in mm) of the landmarks.
Landmark Abbreviation Definition
Dispersion
Intra Inter
Orbitale or Inferior- most point on the
infraorbital margin
L: 0.64
R: 0.86
L: 0.76
R: 1.14
Supraconchion sk Superior- most point on the
supra- orbital margin (excluding
the supra- orbital notch where
present)
L: 0.64
R: 0.61
L: 1.22
R: 0.93
Dacryon dJunction of the sutures between
the frontal, maxillary and
lacrimal bones
L: 0.56
R: 0.77
L: 2.66
R: 2.45
Ectoconchion ek The most lateral point of the
orbital margin following a line
bisecting the orbit from the
dacryon
L: 0.71
R: 0.61
L: 1.04
R: 1.05
Deepest point on the lateral orbital margin dLOM Deepest point on the lateral
orbital margin
L: 0.62
R: 0.50
L: 0.66
R: 0.77
Oculus anterius oa Most anterior point of the
eyeball
L: 0.65
R: 0.67
L: 0.79
R: 0.75
Oculus posterius op Most posterior point of the
eyeball
L: 0.78
R: 0.93
L: 1.42
R: 1.31
Oculus mediale om Most medial point of the eyeball L: 0.78
R: 0.79
L: 1.20
R: 0.92
Oculus laterale ol Most lateral point of the eyeball L: 0.99
R: 0.89
L: 1.15
R: 1.12
Oculus superius os Most superior point of the
eyeball
L: 0.93
R: 1.11
L: 1.24
R: 1.28
Oculus inferius oi Most inferior point of the eyeball L: 1.00
R: 1.22
L: 1.30
R: 1.39
Note: Landmarks adapted from [2, 39, 46].
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4
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VAN der WA LT and OETTLÉ
the orbit, in contrast, the position of the oculus anterius in relation
to the orbital margin can be used to define the protrusion of the eye.
2.4 | Statistical analysis
The PAST v. 4.11 program was used for the statistical analysis of
the data [46]. Repeated measures were performed by the principal
investigator and an independent researcher to determine the intra-
observer and interobserver reliability. The accuracy of the landmark
placement was assessed by performing a dispersion analysis (de-
termining the mean distance between the average position of each
landma rk in relat ion to the re peate d landmar ks) [49]. Results are pre-
sented in Table 1. An intraclass correlation coefficient test (Two- way
random effects, absolute agreement, single rater/measurement: ICC
(2,1)) was performed to determine the reliability and repeatability of
the linear distances (Table 2). Interpretation of the ICC results was
based on the description by Koo and Li, 2016 [50].
A Shapiro–Wilk test was used to determine the distribution of
the data. Univariate analysis (mean, standard deviation, and range)
followed for each sex and population group. To determine the sta-
tistical variance between the sex and population groups, an ANOVA
test was used for parametric data and a Kruskal–Wallis test for non-
parametric data. In order to address the Family–Wise Error Rate and
to prevent Type I errors, ad hoc tests were performed [51–5 4]. For
the parametric data, a Tukey's Pairwise [52] test was used and for
non- parametric test s, a Dunn's pos t hoc test was used, with sequen-
tial Bonfe rroni significan ce [51, 54]. To prevent fal se signific ant com-
pari sons du e to the sm all sample size [55], statistical significance was
set at 5% (p ≤ 0.05) and 0.5% (p ≤ 0.005) [56].
To statistically compare the findings of this study to available
literature in the discussion section of the paper, a comparative
analysis was performed using two- sample t- t e s t s ( BSDA pack-
age in R) and a Bayes Factor calculation (BayesFactor package in
R studio) [57, 58]. The Bayes Factor (BF) quantifies the strength
of evidence for or against the null hypothesis, which states that
there is no difference between population means. A BF between
FIGURE 1 Landmark position on the 3D surface mesh of the
skull.
FIGURE 2 DICOM slice indicating
the landmarks used to calculate ocular
distances between the white squares. (A)
axial view; (B) coronal view; (C) sagittal
view.
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VAN der WA LT and OETTLÉ
−0.5 and 0.5 indicates weak evidence, 0.5–1 indicates moderate
evidence, 1–1.5 indicates strong evidence, 1.5–2 indicates very
strong evidence, and a BF greater than 2 indicates decisive evi-
dence. Negative values indicate evidence for the null hypothesis,
with the same strength as the corresponding positive values. Due
to the extensive nature of the test, the left side was used for com-
parative purposes (Table S1).
3 | RESULTS
The average dispersion of the landmarks for the intra- observer
tests was 0.80 ± 0.19 mm and 1.21 ± 0.49 mm for the interobserver
tests (Table 1). The intraclass correlation coefficient (ICC) indicated
greater repeatability of measurements by the principal investiga-
tor (intra- obser ver) compared to the independent investigator
(interobserver), although agreement followed a similar trend. The
mean ICC for the intra- observer test was 0.73 ± 0.18 and 0.61 ± 0.23
for the interobserver test. Excellent repeatability (ICC >0.9) was
noted for the orbital dimensions. The protrusion of the eyeball from
the orbital margin could be determined with greater repeatability
compared to the position of the eyeball in relation to the orbital rim
(Table 2).
All data were normally distributed in the White South African
sample, except for the right orbital index and right ocular width in
males, while the right orbital breadth and right axial ocular length
were non- parametric in the female group. In Black males, the ocu-
lar indexes, sk- os (right) and d- oa (left) were non- parametric, while
the remainder of the data was parametric. All linear distances in the
Black female sample were parametric, besides the left orbital index,
right ocular width, sk- os, right ek- oa, and right d- oa. Table 3 pres-
ents the summary statistics of the orbital and ocular dimensions, the
TABLE 2 Measurements and repeatability (ICC values) used in the study.
Measurement Abbr Definition
ICC
Intra Inter
Orbital height sk–or Distance between the supraconchion and
the orbitale
L: 0.91
R: 0.84
L: 0.80
R: 0.89
Orbital breadth d–ek Distance between the dacryon and
ectoconchion
L: 0.98
R: 0.90
L: 0.63
R: 0.50
Orbital index (Orbital height/Orbital breadth) * 100 L: 0.91
R: 0.83
L: 0.64
R: 0.42
Ocular height os- oi Distance between the oculus superius and
oculus inferius
L: 0.48
R: 0.29
L: 0.24
R: 0.32
Ocular breadth ol–om Distance between the oculus laterale and
oculus mediale
L: 0.38
R: 0.58
L: 0.29
R: 0.58
Ocular length (Axial length) oa–op Distance between the oculus anterius and
oculus posterius
L: 0.66
R: 0. 51
L: 0.66
R: 0.32
Superior orbital margin (SOM)—
Oculus superius
sk–os Distance between the supraconchion and
the oculus superius
L: 0.82
R: 0.72
L: 0.55
R: 0.73
Inferior orbital margin (IOM)—
Oculus inferius
or— oi Distance between the orbitale and the
oculus inferius
L: 0.53
R: 0.62
L: 0.38
R: 0.44
Medial orbital margin (MOM)—
Oculus mediale
d—om Distance between the dacryon and oculus
mediale
L: 0.75
R: 0.76
L: 0.16
R: 0.11
Lateral orbital margin (49)—
Oculus laterale
ek—ol Distance between ectoconchion and
oculus laterale
L: 0.52
R: 0.71
L: 0.77
R: 0.80
Deepest point of the LOM—
Oculus laterale
dlom–ol Distance from the deepest point on the
lateral orbital margin to the oculus laterale
L: 0.62
R: 0.78
L: 0.65
R: 0.62
Eyeball protrusion dlom–oa Protruded distance between the deepest
point on the lateral orbital margin to the
oculus anterius
L: 0.93
R:0.94
L: 0.93
R:0.86
Superior orbital margin (SOM)—
Oculus anterius
sk—oa Distance between the supraconchion and
the oculus anterius
L: 0.90
R: 0.80
L: 0.71
R: 0.82
Inferior orbital margin (IOM)—
Oculus anterius
or— oa Distance between the orbitale and the
oculus anterius
L: 0.73
R: 0.61
L: 0.83
R: 0.72
Medial orbital margin (MOM)—
Oculus anterius
d—oa Distance between the dacryon and oculus
anterius
L: 0.91
R: 0.91
L: 0.55
R: 0.67
Lateral orbital margin (49)—
Oculus anterius
ek–oa Distance between ectoconchion and
oculus anterius
L: 0.93
R: 0.89
L: 0.91
R: 0.88
Note: Landmarks adapted from [2, 39, 46].
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VAN der WA LT and OETTLÉ
position of the eye in the bony orbit, as well as the results of the
influence of asymmetry, sexual dimorphism, and population affin-
ity. The effect of sex within population groups and the influence of
population affinity within sex groups were further investigated and
presented in Table 4.
Significant asymmetry was noted in the position of the eye
with regard to the following measurements: LOM- ol (p = 0.002) and
L O M - o a ( p = 0.000). The position of the eyes was shifted to the left
as the right eye was positioned closer to the medial orbital margin
(MOM) (mean difference: 0.67 mm) on the right, while closer to the
left orbital margin (ectoconchion) (mean difference: 0.55 mm) on the
left. As expected, the anterior- most point of the eye (oa) was also
closer to the left orbital margin (ectoconchion) (mean difference:
0.97 mm) compared to the right.
The orbital breadth was consistently greater than the orbital
height in all four South African sex- population groups suggesting a
rectangular- shaped orbit in the horizontal plane, although a smaller
variation was noted in White females, suggesting a more square-
shaped orbit in this group (Table 3). Although the orbital height was
significantly larger in White as compared to Black South Africans
and males as compared to females, the orbital breadth was sexually
dimorphic, but not population- specific. With further investigation
with regard to variation among sex- population groups, it was noted
that orbital height and breadth are sexually dimorphic in Black South
Africans, while only orbital breadth varied between White males and
females, which resulted in a greater orbital index of White South
African females than the other sex- population groups (Table 4). A
more profound effect of population affinity was noted when sex
groups were considered in isolation compared to the entire popu-
lation. Similar orbital dimensions were observed in South African
males, while Black South African females had significantly smaller
orbital dimensions compared to White South African females.
Significant population variation could be noted in the ocular
dimensions of South Africans, as recorded in Table 3. Black South
African females presented with significantly smaller ocular dimen-
sions compared to their male counterparts and White South African
females (Table 4).
Based on the distances between the orbital margin and the
equator of the eye, it was noted that the equator of the eyeball
was located significantly deeper within the bony orbit in White
South Africans, compared to Black South Africans in relation to
the superior, inferior and medial orbital margins (Table 5). Sex- and
population- specific variations in the dimensions of the eyeball and
orbit had a direct influence on the position of the eyeball resulting
in greater variation in the ocular position in females compared to
males (Table 6). Greater orbital heights in White females compared
to Black females, lead to greater distances from the superior and
inferior orbital margins to the equator of the eye. Sexual dimorphism
in Black South Africans was observed in the position of the eye in
relation to the superior orbital margins, while sex influenced the po-
sition in White South Africans in the horizontal plane only, which
could be due to significantly greater orbital breadths noted in White
South African males.
The eyeballs of Black South Africans protruded more from the
orbital margins, with significant variation observed at the superior
and lateral (ectoconchion) orbital margins, which appear to be sex-
specific (Table 6). Although Black South African females presented
with significantly smaller ocular and orbital dimensions than White
South African females, protrusion values were greater in this group,
specifically with regard to the superior, medial and lateral orbital
margins. Less variation was observed in the male sample. No sexual
dimorphism was noted in the protrusion values of the Black South
African sample, while the eyeballs of White males protruded signifi-
cantly further from the deepest point of the lateral orbital wall com-
pared to White females.
4 | DISCUSSION
This study assessed the ocular and orbital dimensions in order to
establish the size and position of the eye in the bony orbit in a South
African sample as it is integral in facial approximations [2, 9, 10]. Side,
sex, and population affinity had an influence on the ocular and or-
bital dimensions as well as the eyeball position. Subtle variations in
orbital dimensions and eyeball positioning could cumulatively influ-
ence the accuracy of facial recognition based on the generated fo-
rensic approximation [5, 21].
Rigid reproducibility testing was performed using two statistical
tests, a mean dispersion analysis and an intraclass correlation coef-
ficient test, to ensure reliable results. Hard- tissue landmarks could
be placed with greater accuracy, reflected in the mathematically
calculated dimensions. Poorer repeatability was noted for the soft
tissue landmarks placed on the equator of the eyeball for eyeball
size determination. This was not unexpected as Casselman and col-
leagues (2013) [59] as well as Dorfling and co- workers (2018) [22]
highlight the difficulty in visualizing soft tissue structures on CBCT
scans, which hampers accurate landmark placement. As the scans
were from patients with open eyes, it was easier to locate the oculus
anterius which was placed with great accuracy, as depicted by the
relatively low dispersion analysis results (intra- observer: 0.66 mm;
interobserver: 0.77 mm). This resulted in higher ICC values for the
distances representing the protrusion of the eyeball (Table 2).
The effect of sexual dimorphism and population affinity on
the dimensions and shape of the cranium, including the orbital re-
gion, have been described in the literature [60–72]. In this South
African sample, Black females presented with the smallest orbital
dimensions when compared to the other South African groups,
while the orbital index of White South African females was the
greatest, which indicates a squarer orbit compared to a rectangu-
lar orbit (in the horizontal plane) noted in the other South African
groups. White males displayed the largest orbital dimensions,
which correspond with the literature describing greater cranial
dimensions in this group when compared to other South African
sex- population groups [7 3 –75]. A Bayes Factor calculation facili-
tated a direct statistical comparison of our results to previously
published literature. In contrast with the rectangular orbits in the
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VAN der WA LT and OETTLÉ
TABLE 3 Univariate analysis of distances in mm and p values testing the influence of asymmetry, population affinity and sexual dimorphism of orbital and ocular dimensions.
Measurement Side Black female n = 45 Black ma le n = 49 White female n = 55 White male n = 48 Asymmetry (p) Population (p) Sex (p)
Orbital height L 35.73
2.98
(29.44–42.22)
37. 76
2.28
(33.63–45.06)
37. 3 2
2.28
(30.52–43.60)
38.05
2.15
(33.18–42.78)
0.723 0.016* 0.000**
R35.91
2.94
(28.74–40.23)
37. 7 3
2.69
(32.34–43.93)
37.62
2.06
(3 3.31– 42. 14 )
37. 98
2.39
(33.34–43.35)
0.012* 0.010**
Orbital breadth L40.10
2.79
(35.73–46.30)
42.27
1.62
(39.10– 45. 77)
40. 52
1.45
(37.63–44.60)
42 .76
1.50
(39.41–45.83)
0. 374 0.773 0.000**
R40.14
2.63
(35.55–45.32)
42.54
1.80
(38.10–46.28)
40.56
1.68
(38.02–44.46)
43 .51
2.14
(40.03–48.98)
0.394 0.000**
Orbital index L 89.17
5.09
(8 1 . 8 2–10 3 . 14)
89. 36
5.08
(80.12–106.38)
92.19
6.20
(75.74–108.52)
89. 03
4.66
(77. 34– 98.01 )
0.625 0.030* 0.040*
R89. 53
5.80
(78.84–102.51)
88.73
5.72
(77.06–102.25)
92.87
5.60
(78.14–106.34)
87. 0 4
5.73
(74.36–100.59)
0.028* 0.035*
Ocular breadth (OB) L 22.44
1.60
(19.79–26 .43)
23.34
1.47
(2 0.59–2 6.92)
23.23
1.20
(20.65–26.08)
23.55
1.39
(20.00–26.99)
0.343 0.022* 0.005*
R22.78
1.54
(20.02–26.70)
23.61
1.47
(2 0.72–26. 47 )
23.14
1.38
(20.10–25.85)
23.62
1.49
(21.29–27.31)
0.497 0.002**
Ocular height (OH) L 23.77
1.44
(19.98–26 .40)
24.60
1.86
(20.80–28.40)
23.88
1.43
(20.80–27.20)
25.23
1.55
(22.40–28.80)
0. 511 0.182 0.000**
R23.89
1.66
(20.80–27.85)
23.92
1.97
(18.40–28.00)
23.93
1.40
(20.80–26.80)
25.30
1.47
(22.40–28.40)
0.005** 0.000**
Axial/ocular length (OL) L 21.98
1.23
(18.28–25.10)
23.14
1.30
(20.29–25.85)
23.50
1.22
(20.54–26.31)
23.27
1.17
(20.82–25.68)
0.692 0.000** 0.047*
R22.16
1.36
(19. 2 2–24 . 8 0)
23.39
1.04
(20.90–25.85)
23.27
1.28
(20.12–26.87)
23.32
1.05
(21.26–25.46)
0.007* 0.001**
Note: Bold: mean, Italics: standard deviation, Brackets indicates the minimum and maximum values. Statistically significant *p ≤ 0.05, **p ≤ 0.005.
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8
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VAN der WA LT and OETTLÉ
horizontal plane, noted in this South African sample, statistically
significant differences were noted when compared to Egyptian
[76] and Iranian [77] males and females (BF >2) who present with
a rectangular orbit in the vertical plane.
The orbital height of White South African females corresponded
to the orbital height reported in a Turkish (BF: −0.572) [40] and
Korean [42] (BF: −0.313) sample, while the orbital dimensions of
White South African females were significantly greater than Chinese
[36] (BF: 12.213); White American [37] (BF: 8.399), French [39] (BF:
4.720) and Italian [78] (BF: 4.178) females. Orbital dimensions, and
more specifically orbital height, in Black South African females,
were more comparable to other female groups of French [39] (BF:
−0.652), Korean [79] (BF: −0.612), Egyptian [76] (BF: −0.647) and
Iranian [77] (BF: −0.233) decent. The orbital dimensions of South
African males resembled Turkish [40] (BF: −0.738), Korean [42] (BF:
−0.569), and Iranian [77] (BF: −0.727) males, although significantly
greater dimensions were noted when compared to Chinese [36] (BF:
13.440), White American [37] (BF: 10.305), French [39] (BF: 4.735),
Italian [78] (BF: 5.529) and Japanese [80] (BF: 2.269) males. Sexual
dimorphism in the orbital dimensions, with larger dimensions noted
in males, was not only observed in the current study but has been
reported previously [36, 39, 40, 42, 80].
In contrast to the variations noted in the orbital dimensions of
South Africans, no sexual dimorphism was obser ved in the ocular
dimensions of White South Africans, which translates to relatively
larger eyeballs in White females, located in generally smaller orbits.
The cause of this sex- related difference in White South Africans
remains unclear, but may merely serve a functional purpose, such
as maintaining optimal optical refraction. However, this trend was
not observed in Black females, as all ocular measurements were sig-
nificantly smaller compared to the other South African groups. In
general, the ocular dimensions of South Africans were smaller in all
planes when compared to the literature [22, 79, 81] (BF >2.000 in all
groups), although the ocular axial length of South African males and
White South African females was similar to Turkish [40] (male BF:
−0.744; female BF: −0.680) and European [7] (male BF: −0.448; fe-
male BF: −0.476) samples. These variations emphasize the necessity
for the use of sex- and population- specific eyeballs during the facial
approximation process, rather than the standard- sized eyeballs with
a 25 mm diameter currently used [1 2–1 4].
Interpopulation variation in normative orbital and ocular dimen-
sions within this South African sample influenced the position of the
eyeball within the orbit. The eyeball was often located deeper within
the orbit in White South Africans compared to Black South Africans.
More protruding eyeballs in the vertical and horizontal planes were
noted in Black South African females when compared to White
South African females, regardless of the significantly smaller orbital
and ocular dimensions noted in Black South African females. These
findings support the shallower position of the eyeball of Black South
African females in relation to the superior orbital margin. Less vari-
ation was noted in protrusion values between South African males,
although the eye protruded more from the superior orbital margin
in Black South African males. These variations should be considered
during facial approximations of South African faces.
Stephan and colleagues, 2009 [21] concluded that the eye was
located closer to the superior and lateral orbital walls, with only 2/13
cadavers showing central positioning. The mean distances from the
lateral orbital margin (dLOM) to the oculus laterale (ol) also indicated
that South Africans' eyes are closer to the lateral orbital margin than
the medial orbital margin. The distance from the superior orbital
margin (sk) to the oculus superius (os) was however greater com-
pared to the distance between the inferior orbital margin (or) and oc-
ulus inferius (oi) in this South African sample. The increased distance
could be due to the more projecting superior orbital margin in rela-
tion to the inferior orbital margin [37], leading to an increased calcu-
lated distance, which cannot be compared to the studies performed
TABLE 4 Variation in orbital and ocular linear dimensions between sexes within populations and between populations within sexes.
Measurement Side
Sexual dimorphism within populations Population variation within sex groups
Black south Africans
n = 94
White south Africans
n = 103 SA females n = 100 SA males n = 97
Orbital height L 0.000** 0.426 0.007* 0.932
R0.003** 0.887 0.005** 0.960
Orbital breadth (d- ek) L 0.000** 0.000** 0.926 0.590
R0.000** 0.000** 0.839 0.099
Orbital index (OH/OB *100) L 0.886 0.003** 0.003** 0.946
R0.521 0.000** 0.019* 0.180
Ocular height (OH) L 0.052* 0.000** 0.973 0.181
R0.999 0.002** 0.995 0.002**
Ocular breadth/width (OB) L 0.011* 0.610 0.033* 0.878
R0.003* 0.331 0.106 0.999
Axial length/ocular length (OL) L 0.000** 0.753 0.000** 0.948
R0.000** 0.999 0.000** 0.759
Note: Statistically significant *p ≤ 0.05, **p ≤ 0.005.
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VAN der WA LT and OETTLÉ
TABLE 5 Univariate analysis of distances in mm and p values testing the influence of asymmetry, population affinity and sexual dimorphism of ocular position and protrusion.
Measurement Side Black female n = 45 Black male n = 49 White female n = 55 White male n = 48 Asymmetry (p) Population (p) Sex (p)
SOM- os L9.4 0
1.96
(6 . 24 –13 .76 )
10.6 4
1.84
(6 . 0 6 –1 4 . 3 5)
11.98
1.68
(7.59 –16 . 0 8 )
11.7 8
2.26
(6 . 8 0–17. 3 0)
0.211 0.000** 0.218
R9.5 3
1.40
(7.36–14.03)
11. 20
2.17
(8 .04–17. 32 )
12.28
1. 76
(8 .1 2–17. 3 1 )
12.28
2.20
(7.58–18 .7 3 )
0.000** 0.047*
I O M - o i L8 .99
1.80
(5 . 3 0–11 . 8 9 )
9.0 4
2.22
(4.85–14.63)
10.38
1.83
(5 . 4 4 –14 . 6 8 )
9.6 0
1.30
(6.66–12.61)
0.636 0.000** 0.107
R8.93
2.18
(4 . 9 3–13 .58)
9.2 3
20.3
(5.06–15.41)
10.12
1.50
(7.02–13.45)
9.38
1. 76
(5 . 2 9 –1 2 .98)
0.011* 0.300
MOM- om L11. 57
1.45
(8.74–14.57)
11.97
1.61
(7.9 9 –14 . 76)
11.81
1.45
(9.30–15.45 )
13.13
1.42
(10. 32–1 6 . 4 4 )
0.020* 0.004** 0.000**
R10.70
1.29
(8 .04–14 . 6 1)
12.08
1.75
(8 0.2–1 5 . 6 9)
11.81
1.45
(8.68–14.72)
12. 67
1.67
(9.37–15.64)
0.012* 0.000**
LOM (ek)- ol L 11.84
1.85
(7.42–15.43)
10.86
1.34
(7.82–13.59)
10.44
1.55
(7.32–14.08)
12 .74
1.62
(8.88–16.59)
0.002** 0.482 0.006*
R12.01
1.63
(9.29–1 5 . 4 3 )
10.94
1.67
(7.6 4 –14 . 9 1)
11.80
1.80
(6.68–16.12)
13.31
1.35
(10. 67–16 .31 )
0.000** 0.402
LOM (dLOM)- ol L9.3 9
1.96
(5 . 9 2–14.70)
9.17
1.81
(5 . 4 4–1 3 . 3 7 )
8.29
1.68
(4 . 7 0 –1 2 . 3 4 )
9.3 0
1.98
(5.60–13.89)
0.592 0.057 0.096
R9.4 5
11.6 9
(5.09–13.94)
9.0 7
1.84
(5 . 9 9–13 . 4 6 )
8.23
1.50
(4 . 9 9–11 . 3 7 )
9.6 5
1.49
(6.38–12.30)
0.142 0.018*
Protrusion (dLOM—oa) L24.02
2.26
(19.15–28 . 3 4)
24.60
1.91
(20.44–28.10)
23.59
1.61
(2 0 . 5 5–27.9 2 )
25.16
1.81
(21.71–28.98)
0.080 0.991 0.000**
R24.17
1.91
(2 0.18–2 9.62 )
24.31
1.89
(2 0.35–28 .93 )
22.89
1.97
(18.78–26.72)
24.66
1.90
(2 0.95–2 9.13)
0.066 0.000**
(Continues)
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VAN der WA LT and OETTLÉ
Measurement Side Black female n = 45 Black male n = 49 White female n = 55 White male n = 48 Asymmetry (p) Population (p) Sex (p)
S O M - o a L21.31
2. 74
(15. 71–2 6 .43)
20.84
2.04
(16.46–26.61)
19. 59
2.06
(14.55–24.73)
19.65
1.85
(15. 8 7–23.6 2)
0.942 0.000** 0.725
R20.95
2. 51
(14.84–25.13)
21.00
2.12
(16.25–26.64)
19. 58
2.15
(13 .95–24.4 5)
19.60
2.05
(14.09–23.32)
0.000** 0.729
IOM- oa L20 .51
2.90
(15.26–26.70)
19.7 0
1.99
(15.88–25.08)
20.13
1.80
(15.96–23 .79 )
20.42
1.75
(17.05–24.80)
0.069 0.480 0. 276
R19.76
2.59
(14.73–24.80)
19.00
1.96
(14 .59–23 .69)
20.08
2.10
(16 . 01–24 .45 )
19.9 2
2.01
(15.86–25.26)
0.039* 0.116
M O M - o a L23.35
2.47
(18.63–27.85)
23.20
1.97
(16.59–26.65)
22.81
1.67
(19.12–2 6.95)
24.33
1.71
(21. 5 3–28 . 33)
0.266 0.394 0.014*
R24.70
3.93
(19. 03–35 . 31 )
22.89
1.90
(17.7 1–2 7. 3 0 )
22.57
2.02
(18 . 61–26 .9 2)
23.66
1.94
(19. 68–2 9.08)
0.308 0.495
L O M - o a L23.79
1.53
(2 0.19–26 . 5 4)
24.14
1.77
(2 0 .13–2 7. 5 6)
22.81
2.25
(17.78–29.35)
23.50
1.63
(19.13–27.03)
0.000** 0.002** 0.034*
R25.25
3.71
(18.40–33.88)
24.72
2.08
(19.72–30.31)
23.45
1.84
(19. 58–2 7.19 )
24.70
1.69
(21. 18 –28. 75 )
0.028* 0.020*
Note: Bold: mean, Italics: standard deviation, Brackets indicates the minimum and maximum values. Statistically significant *p ≤ 0.05, **p ≤ 0.005.
TABLE 5 (Continued)
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11
VAN der WA LT and OETTLÉ
by Stephan et al. (2009) [21] or Dorfling et al. (2018) [22] who calcu-
lated the position of the eye to the closest orbital wall, rather than
the orbital margin.
The eyeball of South Africans protruded more from the deepest
point of the lateral orbital margin compared to studies conducted
on Australian [21], French [39], Black, and White Americans [44] as
well as Japanese adults [80] (BF: >2.000). However, protrusion with
regard to the dacryon was only 2–3 mm greater in South Africans.
The significant variations noted between these studies could be as-
cribed to population variation, but gravitational effects on the CT
and cadaveric tissue, the small sample size [21], and the average val-
ues representing males and females should be noted. Another factor
that should be investigated further is the effect of nutritional status
and body mass index (BMI) on the position and protrusion of the
eyeball from the orbital rim, as it was reported to lead to increased
protrusion values in a Japanese sample [80, 82]. Sexual dimorphism
is commonly observed in ocular protrusion regardless of the method
or modality used. As in this study, males in general, present with
larger protrusion values compared to their female counterparts [39,
44].
The effect of gravity on the soft tissue structure of the face has
been investigated. Martin and colleagues (2015) noticed that gravity
influences the soft tissue structure of the face and indicated a maxi-
mum extension strain of up to 15% in the infraorbital region between
the upright and supine posit ion [83]. In a more recent study by Munn
and Stephan (2018) based on high- resolution dimensional imaging
stereo- photographs, the inferolateral soft tissue covering the orbit
retracts laterally in the supine position [25]. However, the effect of
gravity on the position of the eyeball has not been quantified.
5 | CONCLUSION
This study emphasizes that variations in the average dimensions of
the eye and orbit exist between sex and population groups which di-
rectly affect the eye's position in the orbit. These findings highlight the
need for the creation and use of sex- and population- specific guide-
lines to produce accurate facial approximations of South Africans.
For Black South African females, given their significantly smaller
eyeballs compared to other South African groups, an eyeball size of
21.98 × 22.44 × 23.77 mm is recommended, while the normative ocu-
lar size of White South African females is 23.50 × 23.23 × 23.88 mm.
Due to the similarity in the ocular dimensions of South African
males, a mean eyeball size of 23.21 × 23.45 × 24.92 mm should be
considered. The use of CBCT scans to establish ocular position and
protrusion is valuable, as the effect of gravity can be negated while
more precise measurements can be obtained from superior image
resolution compared to CT scans [22, 59, 84].
TABLE 6 Variation in ocular position and protrusion between sexes within populations and between populations within sexes.
Measurement Side
Sexual dimorphism within populations Population variation within sex groups
Black south Africans
n = 94
White south Africans
n = 103 SA females n = 100 SA males n = 97
SOM- os L0.007* 0.560 0.000** 0.021
R0.000** 0.868 0.000** 0.006
I O M - o i L0.999 0.137 0.001** 0.426
R0.878 0.188 0.001** 0.980
MOM- om L0.549 0.000** 0.842 0.000**
R0.000** 0.001** 0.044* 0.247
LOM (ek)–ol L 0.016* 0.000** 0.000** 0.000**
R0.009* 0.000** 0.921 0.000**
LOM (dLOM)–ol L0.943 0.033* 0.019* 0.987
R0.665 0.000** 0.001** 0.293
Protrusion: (dLOM—oa) L0.457 0.000** 0.667 0.470
R0.986 0.000** 0.006* 0.813
S O M - o a L0.725 0.999 0.001** 0.039*
R0.999 0.999 0.013* 0.011*
IOM- oa L0.127 0.985 0.759 0.605
R0.332 0.982 0.879 0 .162
M O M - o a L0.721 0.000** 0. 527 0.011*
R0.078 0.010* 0.004** 0.455
LOM (ek)- oa L 0.788 0.237 0.044* 0.312
R0.856 0.003** 0.005** 0.999
Note: Statistically significant *p ≤ 0.05, **p ≤ 0.005.
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VAN der WA LT and OETTLÉ
ACKNOWLEDGMENTS
The authors would like to express sincere gratitude to Dr. S Botha
for granting permission to collect scans from his private practice.
Special thanks are extended to the individuals from the Forensic
Anthropology Research Centre (FARC) at the University of Pretoria
for the critical review of the study proposal. We are thankful to
Professor D Vandermeulen who created the MeVisLab network
used to collect the data and Ms. M Meyer for conducting the inter-
observer error.
CONFLICT OF INTEREST STATEMENT
The authors declare that they have no competing interests to
disclose.
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SUPPORTING INFORMATION
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Supporting Information section at the end of this article.
How to cite this article: Van der Walt S, Oettlé AC.
Dimensions and position of the eye for facial approximations
in a South African cone beam computed tomography sample.
J Forensic Sci. 2024;00:1–14. https://doi.org /10.1111/1556-
4029.15693
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