Enophthalmos

Beyond the aesthetic impact, enophthalmos does not cause ocular or visual symptoms as such. Due to its appearance, this disorder is often confused with the so-called false enophthalmos, caused by drooping eyelids (eyelid ptosis), the decrease in the size of the eyeball (microphthalmos), an exophthalmos in the opposite eye (which makes the healthy one look sunken) or Horner’s syndrome (injury to the sympathetic facial nerves, which is characterised by contracted pupils, drooping eyelids …), which makes the eye look retracted, when in fact it is not.

• Orbital fracture: The breakage of any of the bones that make up the eye socket is likely to cause enophthalmos. These fractures are usually due to a blow or fall.
• Breast cancer: A variable percentage of metastatic breast cancer cases cause retraction and fibrosis of the orbital tissues, resulting in enophthalmos.
• Orbital fat atrophy: Enophthalmos due to fat decrease in this facial part affects both eyes (bilateral enophthalmos) and is mainly linked to aging or chronic inflammation.
• Severe trauma: a strong blow to the eye can cause a unilateral enophthalmos, which only affects the area that suffers the incident.

Enophthalmos treatment involves a differential diagnosis, based on the following:

• An exhaustive eye examination in the ophthalmologist’s office, where we include the assessment of the periorbital and eyelid areas; that is to say, the entire contour of the eyes and eyelids.
• An orbital CT scan, especially if trauma has occurred, in order to locate the cause of enophthalmos and determine its extent.
• An exophthalmometry, a test that measures the position of both eyes and is also known as the Hertel test.

Based on the findings of these diagnostic tests, oculoplastic surgeons at the Miranza clinics perform a surgical reconstruction of the eye orbit, either by placing plates (if the enophthalmos is due to an orbital fracture) or by grafting skin and/or fat (in addition to the plates). This technique is a common resource when enophthalmos is caused by retraction of the eyeball, associated with cancer processes or trauma affecting soft tissues, not just bone.