Enophthalmos Workup

  • Author: Charles NS Soparkar, MD, PhD; Chief Editor: Hampton Roy Sr, MD   more...
 
Updated: Feb 16, 2010
 

Laboratory Studies

  • Neuroimaging is the most essential laboratory study in patients with enophthalmos.
  • The remainder of the studies are guided by suspected etiology.
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Imaging Studies

  • CT scan of the orbits
    • Coronal images are best to evaluate blow-out fractures and changes associated with the maxillary sinus.
    • Axial images best demonstrate orbital fat atrophy.
    • Rapid spin or spiral technology is useful for demonstrating varix during a Valsalva maneuver.
  • MRI with fat suppression, surface coils, and enhancement is best for characterizing neoplastic infiltrations.
  • Bone scans are infrequently helpful to identify areas of bone inflammation seen with osteomyelitis or inflammatory wasting disorders.
  • Old photographs can help to determine the rate of progression of the problem or an unrecognized congenital facial asymmetry.
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Other Tests

  • Relate to the specific suspected disease process (For example, for suspected contralateral orbital tumor, systemic evaluation for a primary malignancy or metastatic disease should be performed.)
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Procedures

  • Open biopsy may be indicated, but needle biopsy is rarely helpful in the diagnosis of enophthalmos.
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Histologic Findings

  • The wide range of causes for enophthalmos provides a wide range of histopathologic findings.
  • One of the most curious findings may be silent sinus syndrome, in which spontaneous enophthalmos and hypoglobus occur over days to years without any associated trauma and the histopathology shows only mild, chronic mucosal inflammation and bone reparative changes.[2, 3, 4]
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Contributor Information and Disclosures
Author

Charles NS Soparkar, MD, PhD  Clinical Assistant Professor, Department of Ophthalmology, Cullen Eye Institute, Baylor College of Medicine; Deputy Chief, Department of Ophthalmology, Methodist Hospital of Houston

Disclosure: Nothing to disclose.

Specialty Editor Board

Jorge G Camara, MD  Professor of Ophthalmology, Department of Surgery and Director of Fellowship Training Program in Ophthalmic Plastic and Reconstructive Surgery for Countries Served by the Aloha Medical Mission, University of Hawaii John A Burns School of Medicine

Jorge G Camara, MD is a member of the following medical societies: American Academy of Ophthalmology, American Medical Association, and American Society of Ophthalmic Plastic and Reconstructive Surgery

Disclosure: Nothing to disclose.

Francisco Talavera, PharmD, PhD  Senior Pharmacy Editor, eMedicine

Disclosure: eMedicine Salary Employment

Mark T Duffy, MD, PhD  Consulting Staff, Division of Oculoplastic, Orbito-facial, Lacrimal and Reconstructive Surgery, Green Bay Eye Clinic, BayCare Clinic; Medical Director, Advanced Cosmetic Solutions, A BayCare Clinic

Mark T Duffy, MD, PhD is a member of the following medical societies: American Academy of Ophthalmology, American Medical Association, American Society of Ophthalmic Plastic and Reconstructive Surgery, Sigma Xi, and Society for Neuroscience

Disclosure: Allergan - Botox Cosmetic Consulting fee Consulting

Lance L Brown, OD, MD  Ophthalmologist, Affiliated With Freeman Hospital and St John's Hospital, Regional Eye Center, Joplin, Missouri

Disclosure: Nothing to disclose.

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, and Pan-American Association of Ophthalmology

Disclosure: Nothing to disclose.

References

  1. [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].

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

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

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

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

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

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

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

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

  10. 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. Feb 1986;77(2):193-202. [Medline].

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

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