Enophthalmos Workup

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

Laboratory Studies

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  • 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

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  • 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

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  • 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

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

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  • 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]
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