Enophthalmos Treatment & Management

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

Medical Care

Medical treatments in patients with enophthalmos are directed at specific diseases such as chemotherapy or ionizing radiation for metastatic disease or immunosuppressive treatments for inflammatory disorders. Once the disease process is stabilized, nonsurgical management may include camouflage glasses (hyperopic [magnifying] correction over myopic contact lens).

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Surgical Care

Once medical or surgical treatment of the underlying process is achieved, correction of enophthalmos begins with approximating normal orbital bone positions before addressing soft tissue volume loss. [7, 8]

  • Orbital fracture repair includes the following: [9]
    • Maintain the convexity of the posterior, medial orbital floor. [10]
    • Stabilize floor implants posteriorly on intact floor ledge.
    • Release any major adhesions or scar bands to allow mobilization of soft tissues. In late posttraumatic cases, sharp rather than blunt dissection is often required. [11]
    • If using bone grafts rather than synthetic materials, allow for 15-30% resorption.
    • Overcorrect to obtain 1-2 mm of exophthalmos intraoperatively.
    • Perform forced duction testing of the globe prior to closure.
  • In replacing lost orbital soft tissue volume, perform the following:
    • A forward traction test on the globe to determine the amount of correction possible
    • Augment from the orbital walls inward with bone or synthetic materials. For pure enophthalmos correction without hypoglobus, inferolateral and retrobulbar mass effect is desirable.
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Consultations

Consultation with oculoplastic surgery or neuro-ophthalmology may be useful in defining the cause of enophthalmos.

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Activity

Activity restrictions depend on the etiology.

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