After repair of an orbital floor fracture, delayed enophthalmos can occur secondary to an increase in orbital volume or a reduction of soft-tissue orbital contents.
Our patient's enophthalmos was likely the result of two causes: the slightly inferior placement of the reconstruction mesh and the loss of soft tissue, and thus our simple approach was suitable for correcting it.
4) Moreover, it is generally accepted that approximately 2 mm of enophthalmos must be present before it becomes noticeable.
Diplopia and enophthalmos after surgical repair of blowout fracture.
8-10) In order for enophthalmos to occur, retraction of the orbital floor is necessary; the retraction leads to an increase in orbital volume.
Physical examination revealed left enophthalmos, deepening of the superior orbital sulcus, loss of the lower-eyelid fat, and malar depression (figure 1).
Differential diagnoses that should be considered in patients with asymptomatic enophthalmos are Parry-Romberg syndrome (facial hemiatrophy), linear scleroderma, metastasis, osteomyelitis, atrophy of the orbital contents, orbital varix, chronic sinusitis, cysts, and pseudoenophthalmos, among others.
A two-stage approach has been used that entails giving the enophthalmos an opportunity to spontaneously resolve.
Ophthalmologic examination revealed a prominent left superior palpebral sulcus, 2 mm of inferior globe displacement (hypoglobus), and 3 mm of enophthalmos as compared with his contralateral eye.
Although he experienced a prompt resolution of the enophthalmos, the postoperative course was complicated by the development of symptomatic left frontal sinusitis, which was unresponsive to medical therapy.
Enophthalmos resulting from maxillary sinus pathology was first reported by Montgomery in 1964.
A trend that we noted upon reviewing the literature was that patient recognition of progressive enophthalmos over a period of 3 months or less corresponded with an attenuation or absence of the involved bony sinus walls, whereas a more insidious development of this change corresponded with bony remodeling.