Enophthalmos, briefly, is the backward displacement of the eye due to the expansion of the orbit, or the eye socket, causing one eye to be positioned behind the other. Although we mentioned “eye contraction” in the title, it is actually the perception of the eye appearing smaller due to the enlargement of the eye socket.
Causes of Enophthalmos:
- Some congenital diseases
- Certain orbital tumors
- Silent sinus syndrome
- And most importantly, a common cause is orbital trauma
What is Pseudoenophthalmos, and what are its causes?
As the name suggests, pseudoenophthalmos does not involve actual enophthalmos. Instead, there are reasons that create the appearance of one eye being smaller.
- Eyelid drooping (ptosis): Patients often describe eyelid drooping as “my eye has shrunk.” In reality, there is eyelid drooping, and due to the drooping, the pupil is not fully visible, leading to the perception of a smaller eye.
- Unilateral high myopia: High myopia enlarges the dimensions of the front and back of the eye. Therefore, unilateral myopia can make one eye appear larger than the other.
- Downward pulling of the lower eyelid: Trauma or certain diseases can cause one eye’s lower eyelid to pull downward, creating the illusion of shrinkage in the other eye.
- Strabismus: Misalignment of one eye can also cause the appearance of pseudoenophthalmos.
- Exophthalmos: Exophthalmos is the opposite of enophthalmos, where the eye protrudes forward. Trauma, tumors developing behind the eye, unilateral eye involvement in thyroid-related eye disease, and some inflammatory diseases of the orbit can cause exophthalmos. Patients may sometimes perceive this as the shrinking of the other eye, but the actual issue is the enlargement of the opposite eye.
Why does enophthalmos occur after trauma?
Enophthalmos is quite common after trauma to the orbit or eye socket. Traffic accidents, impacts, blunt trauma to the orbit, such as a punch, can cause fractures in the bones forming the eye socket. Anatomically, there are air cavities called sinuses in the lower, inner, and upper parts of the eye socket, or the orbit. When fractures occur in these bones during orbital trauma, they may open towards the sinus cavities. As a result, the bony cavity housing the eye expands. When the orbital cavity expands, the eye and the surrounding tissues move backward, leading to enophthalmos.
Sometimes, enophthalmos can develop in the late period after trauma without orbital bone fractures. This can happen because there are numerous fat pockets around and behind our eyes. One of the essential functions of these fat pockets is to act as an airbag during trauma, protecting the eye. In some cases, even if there are no fractures in the surrounding bones during blunt trauma, atrophy, or the death of fat cells behind the eye can occur over time. Therefore, enophthalmos may develop in the late period after trauma.
What kind of complaints does enophthalmos cause?
- Sensation of the eye moving backward, leading to a feeling of eye contraction
- Eyelid drooping
- Facial asymmetry
- Double vision
- Inward turning of the eyelid (Entropion)
- Tearing
- Blurred vision
- Deepening of the eye socket
What should I do if my eye has shrunk?
Firstly, you should consult an eye doctor. Basic eye examinations, including visual acuity, anterior and posterior segment examinations, light reflex, and eye movements, should be performed. Subsequently, eyelid measurements and measurements of eye sizes using an instrument called Hertel exophthalmometry should be taken. Then, for more detailed information about the orbit, orbital tomography (CT) or magnetic resonance (MR) imaging should be performed. These imaging techniques can help identify traumas occurring in the orbital cavity, tumors developing behind the eye, and many other diseases.
Is there a treatment for enophthalmos?
Certainly, in brief, we can say yes. Like in all diseases, the most crucial aspect is to make a correct diagnosis. After a correct diagnosis is made, a treatment approach can be taken towards the underlying cause. If there are fractures in the orbit bones, they should be repaired, and if there is a tumor pushing the eye backward, it should be removed.