If enopthalmos is due to trauma or surgery cosmetic improvement can be achieved by keratopigmentation (corneal tattoo) and retrobulbar(behind the eye) filler injection.
What is Enophthalmos?
(photo by AI)
Enophthalmos is a condition where the eyeball is displaced backward into the eye socket (orbit). This posterior displacement gives the eye a sunken appearance compared to the normal position. The condition can be mild and barely noticeable, or it can be severe, causing significant facial asymmetry and visual disturbances.
Causes of Enophthalmos
The causes of enophthalmos can be varied and include:
- Orbital Trauma:
- Blowout Fractures: Trauma to the orbit, such as from a blunt force impact, can result in fractures of the orbital bones. When the thin bones that form the floor or medial wall of the orbit break, the contents of the orbit can herniate into the adjacent sinuses, leading to enophthalmos.
- Retrobulbar Hemorrhage: Bleeding behind the eyeball can cause a decrease in the volume of the orbital contents, resulting in a sunken eye.
- Fat Atrophy:
- Aging: As people age, there is a natural loss of orbital fat, which can cause the eye to appear more sunken. This is usually a gradual process.
- Systemic Diseases: Certain systemic conditions, such as scleroderma or other connective tissue diseases, can lead to the atrophy of orbital fat and enophthalmos.
- Involutional Changes: Involutional enophthalmos is related to the natural aging process and the loss of fat or muscle tissue around the eye.
- Scarring or Fibrosis:
- Post-Surgical Changes: After surgery in the orbital region, especially procedures that involve removing tissue or treating tumors, scar tissue can form, leading to fibrosis and pulling the eye backward.
- Inflammatory Conditions: Chronic inflammation within the orbit, such as from conditions like orbital pseudotumor or thyroid eye disease, can lead to fibrosis and subsequent enophthalmos.
- Silent Sinus Syndrome:
- This rare condition involves the gradual collapse of the maxillary sinus, which can cause the orbital floor to descend and the eye to become sunken. Silent sinus syndrome is typically painless and progresses slowly, often being diagnosed when patients notice facial asymmetry.
- Oncologic Causes:
- Orbital Tumors: Tumors within the orbit can cause displacement of the eyeball. Depending on the tumor’s location, it can either push the eye forward (proptosis) or cause enophthalmos if it creates space by eroding or displacing bone or fat.
- Congenital Causes:
- Some individuals may be born with congenital enophthalmos due to underdevelopment of the orbit or surrounding structures.
Symptoms of Enophthalmos
Patients with enophthalmos may present with:
- Sunken Eye Appearance: The most noticeable symptom is a visible retraction of the eye within the orbit, which can cause facial asymmetry.
- Double Vision (Diplopia): Depending on the cause and severity, the displacement of the eye can alter the visual axis, leading to double vision.
- Visual Disturbances: Reduced visual field or blurred vision can occur if the condition is severe.
- Reduced Mobility of the Eye: In some cases, particularly when scarring or fibrosis is involved, the eye may not move as freely within the orbit.
Diagnosis
The diagnosis of enophthalmos usually involves:
- Physical Examination: A thorough eye examination, including measurements of the eye position relative to the orbit.
- Imaging Studies: CT (Computed Tomography) or MRI (Magnetic Resonance Imaging) scans are often used to assess the bony structures of the orbit and to identify any underlying conditions, such as fractures, tumors, or sinus issues.
- Visual Function Tests: Assessing the impact of enophthalmos on vision, including tests for diplopia and visual field defects.
Treatment of Enophthalmos
Treatment for enophthalmos depends on the underlying cause and the severity of the condition:
- Surgical Intervention:
- Orbital Reconstruction: In cases of traumatic enophthalmos, surgical repair may involve reconstructing the orbital floor or walls using implants to restore the eye to its normal position.
- Fat Grafting or Orbital Implants: To correct volume loss, fat grafting or the placement of orbital implants may be used to restore the natural contour of the eye.
- Endoscopic Sinus Surgery: For conditions like silent sinus syndrome, surgery to restore the normal anatomy of the sinus can help correct the enophthalmos.
- Non-Surgical Management:
- Observation: In mild cases, or where the condition is stable and not causing significant symptoms, monitoring may be all that is required.
- Management of Underlying Conditions: Treating the underlying cause, such as controlling inflammation in thyroid eye disease, can sometimes improve enophthalmos.
- Cosmetic Correction:
- In cases where enophthalmos is primarily a cosmetic concern, various surgical and non-surgical options can be considered to improve facial symmetry and appearance.
Prognosis
The prognosis for enophthalmos depends largely on the cause and the success of treatment. In cases of trauma or silent sinus syndrome, surgical correction can often restore the eye to a normal or near-normal position. However, in cases involving severe scarring or fat atrophy, complete correction may be more challenging, and the focus may be on improving appearance and function as much as possible.
Enophthalmos is a condition that not only affects the aesthetics of the face but can also have significant functional implications. Early diagnosis and appropriate management are key to achieving the best possible outcomes.
