Enophthalmos Workup

Updated: Sep 20, 2018
  • Author: Charles NS Soparkar, MD, PhD; Chief Editor: Hampton Roy, Sr, MD  more...
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Laboratory Studies

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


Imaging Studies

The following imaging studies might be considered:

  • CT scan of the orbits
    • This is often the best first imaging study.
    • 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 contrast 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.
  • Plain films may provide gross assessment relative orbit sizes but do not provide adequate information about soft-tissue volume.
  • Old photographs can help to determine the rate of progression of the problem or an unrecognized congenital facial asymmetry.

Other Tests

Other tests are determined by the specific suspected disease process. For example, in the case of suspected contralateral orbital tumor, systemic evaluation for a primary malignancy and metastatic disease should be performed.



Open biopsy may be indicated. Needle biopsy is rarely helpful in the diagnosis of enophthalmos.


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. [4, 5, 6]



The degree of enophthalmos is usually measured in millimeters relative to the contralateral eye and documented as millimeters of relative enophthalmos.