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Enophthalmos

  • Author: Charles NS Soparkar, MD, PhD; Chief Editor: Hampton Roy, Sr, MD  more...
 
Updated: Sep 30, 2014
 

Background

Enophthalmos is posterior displacement of the eye. The anterior projection of the eye is most commonly measured relative to the outer edge of the orbit, the orbital rim, but may also be assessed relative to the frontal and maxillary prominences, or the contralateral eye. An image of the eye and orbit anatomy is presented below.

Eye and orbit. Eye and orbit.
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Pathophysiology

Primary enophthalmos indicates a congenital etiology. Some degree of facial asymmetry is common, but congenital relative enophthalmos or ocular retrusion may occur with in utero maldevelopment (eg, plagiocephaly, microphthalmos).

Secondary enophthalmos is due to an acquired change in the volumetric relationship between the rigid bone cavity, the orbit, and its contents (predominantly the orbital fat and the eye). Expansion of the orbital cavity without change in the volume of the orbital contents (ie, a blow-out fracture) leads to enophthalmos.[1] An example of a blow-out fracture is shown in the image below.

Conventional frontal tomograph of a blow-out fractConventional frontal tomograph of a blow-out fracture.

Alternatively, scarring contracture of the orbital fat and extraocular muscles may decrease soft tissue volume, making the orbital cavity less full and causing enophthalmos.

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Epidemiology

Frequency

United States

Enophthalmos is common.

International

Same as in the United States.

Mortality/Morbidity

Enophthalmos greater than 2 mm relative to the contralateral eye creates an observable cosmetic deformity. Depending on the etiology, other significant morbidity may be associated.

Age

This condition occurs in all ages.

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Contributor Information and Disclosures
Author

Charles NS Soparkar, MD, PhD Clinical Associate Professor, Department of Ophthalmology, Baylor College of Medicine; Clinical Specialist, Department of Plastic Surgery, MD Anderson Cancer Center; Deputy Chief, Department of Ophthalmology, Methodist Hospital of Houston

Disclosure: Nothing to disclose.

Specialty Editor Board

Francisco Talavera, PharmD, PhD Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Received salary from Medscape for employment. for: Medscape.

Chief Editor

Hampton Roy, Sr, MD Associate Clinical Professor, Department of Ophthalmology, University of Arkansas for Medical Sciences

Hampton Roy, Sr, MD is a member of the following medical societies: American Academy of Ophthalmology, American College of Surgeons, Pan-American Association of Ophthalmology

Disclosure: Nothing to disclose.

References
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  2. Hwang K, Huan F, Hwang PJ. Diplopia and enophthalmos in blowout fractures. J Craniofac Surg. 2012 Jul. 23(4):1077-82. [Medline].

  3. [Guideline] Children's Oncology Group. Long-term follow-up guidelines for survivors of childhood, adolescent, and young adult cancers. Sections 38-91: radiation. Bethesda (MD): Children's Oncology Group; 2006 Mar. [Full Text].

  4. Soparkar CN, Patrinely JR, Cuaycong MJ, et al. The silent sinus syndrome. A cause of spontaneous enophthalmos. Ophthalmology. 1994 Apr. 101(4):772-8. [Medline].

  5. Soparkar CN, Patrinely JR, Davidson JK. Silent sinus syndrome-new perspectives?. Ophthalmology. 2004 Feb. 111(2):414-5; author reply 415-6. [Medline].

  6. Arikan OK, Onaran Z, Muluk NB, Yilmazbas P, Yazici I. Enophthalmos due to atelectasis of the maxillary sinus: silent sinus syndrome. J Craniofac Surg. 2009 Nov. 20(6):2156-9. [Medline].

  7. Kang SJ, Kim JW. Surgical treatment of enophthalmos using an endoscope and T-shaped porous polyethylene fabricated with a mirror image. Int J Oral Maxillofac Surg. 2012 Oct. 41(10):1186-91. [Medline].

  8. Kim YH, Ha JH, Kim TG, Lee JH. Posttraumatic enophthalmos: injuries and outcomes. J Craniofac Surg. 2012 Jul. 23(4):1005-9. [Medline].

  9. Cole P, Kaufman Y, Hollier L. Principles of facial trauma: orbital fracture management. J Craniofac Surg. 2009 Jan. 20(1):101-4. [Medline].

  10. Kim HS, Kim SE, Evans GR, Park SH. The usability of the upper eyelid crease approach for correction of medial orbital wall blowout fracture. Plast Reconstr Surg. 2012 Oct. 130(4):898-905. [Medline].

  11. Hazani R, Yaremchuk MJ. Correction of posttraumatic enophthalmos. Arch Plast Surg. 2012 Jan. 39(1):11-7. [Medline]. [Full Text].

  12. Cline RA, Rootman J. Enophthalmos: a clinical review. Ophthalmology. 1984 Mar. 91(3):229-37. [Medline].

  13. Cory RC, Clayman DA, Faillace WJ, et al. Clinical and radiologic findings in progressive facial hemiatrophy (Parry-Romberg syndrome). AJNR Am J Neuroradiol. 1997 Apr. 18(4):751-7. [Medline].

  14. Davidson JK, Soparkar CN, Williams JB, et al. Negative sinus pressure and normal predisease imaging in silent sinus syndrome. Arch Ophthalmol. 1999 Dec. 117(12):1653-4. [Medline].

  15. Eubanks LE, McBurney EI, Galen W, et al. Linear scleroderma in children. Int J Dermatol. 1996 May. 35(5):330-6. [Medline].

  16. Manson PN, Clifford CM, Su CT, et al. Mechanisms of global support and posttraumatic enophthalmos: I. The anatomy of the ligament sling and its relation to intramuscular cone orbital fat. Plast Reconstr Surg. 1986 Feb. 77(2):193-202. [Medline].

  17. Numa WA, Desai U, Gold DR. Silent sinus syndrome: a case presentation and comprehensive review of all 84 reported cases. Ann Otol Rhinol Laryngol. 2005 Sep. 114(9):688-94. [Medline].

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Eye and orbit.
Conventional frontal tomograph of a blow-out fracture.
 
 
 
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