Enophthalmos

Specialty: Ophthalmology.

• sunken eye
• posterior displacement of the eyeball

Why it occurs

• Fracture of the floor or medial wall of the orbit (burst fracture or post-traumatic blow-out)
• Idiopathic senile atrophy of retrobulbar orbital fat
• Long-term Horner syndrome (causes pseudoenophthalmos due to narrowing of the eyelid fissure and mild eyelid ptosis)
• Retractile orbital metastasis (classically secondary to lobular breast carcinoma with reactive scar fibrosis)
• Progressive hemifacial atrophy (Parry-Romberg Syndrome)

Initial workup

Computed Tomography (CT) of the orbits and facial mass with fine coronal and sagittal reconstruction without contrast (method of choice to visualize orbital bone fractures and the degree of soft tissue herniation towards the maxillary or ethmoid sinus); Forced duction test (with conjunctival forceps under topical anesthesia to differentiate mechanical muscle entrapment from oculomotor nerve palsy); Pre- and postoperative photographic record.

Standard management

• There is no direct ophthalmic pharmacological treatment available for structurally caused enophthalmos; The remedial management consists of the surgical reconstruction of the orbital walls through osteosynthesis and biocompatible implants.
• Deflazacort (orally, 30 mg to 60 mg daily in a rapid tapering regimen after acute orbital trauma to reduce the secondary inflammatory component and edema before definitive surgical evaluation).