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A-Z Glossary

Table of Contents

Enophthalmos

Courtney Dryer, OD
Written byCourtney Dryer, OD
Courtney Dryer, OD
Courtney Dryer, ODOptometristCharlotte, NC

Bio

Dr. Courtney Dryer earned her doctorate from Southern College of Optometry, Memphis, Tennessee in 2011. She opened her own practice Autarchic Spec Shop in 2013 in Charlotte, NC. She has had the privilege of writing for numerous optometric publications and serving in various industry capacities. In 2015, Vision Monday named her a rising star and one of the most influential women in optometry. Her optometric passions include practice management, specialty contact lenses, and dry eye management.

  • Last updated December 20, 2022

What is Enophthalmos?

Enophthalmos is when one eye is deeper into the eye socket compared to the other eye. The condition is also called “sunken eyes”, and can be congenital (present at birth) or acquired (caused by something that happens to you). It can affect one or both eyes.

Enophthalmos occurs due to trauma, disease, and in patients with cancer metastasis (cancer that has spread).

Key Points

  • Enophthalmos describes a condition when one eye appears sunken within the orbit.
  • Enophthalmos can be congenital (present at birth) or acquired (caused by something that happens to you).
  • Causes of the condition include trauma and disease, and is often treated with surgery.
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Understanding Enophthalmos

Congenital enophthalmos may occur due to silent sinus syndrome. Secondary enophthalmos is often due to trauma to the face, such as after a car accident or fight. Other causes can include:

  • Surgery around the eye socket
  • Radiation therapy to the head over long periods
  • Dehydration
  • Inflammation or infection
  • Metastatic cancers
  • Diseases such as Parry–Romberg syndrome and HIV 
  • Sclerodoma (an autoimmune condition)
  • Certain glaucoma medications
  • Bone loss due to aging

Symptoms

In most cases of congenital deformities and trauma, the condition gets worse over time. The related swelling and inflammation following trauma may prevent complete repair. Congenital enophthalmos continues to progress as specific parts of the face develop and others do not.

Symptoms depend on the cause and severity but the most common are facial asymmetry and double vision. Other signs include:

  • Trouble with focus
  • Dry eyes
  • Sagging upper eyelids (ptosis)
  • Deep groove in eyelids (sulcus)

Diagnosis

Neuroimaging is crucial for diagnosis, and other testing may be needed depending on the suspected cause. For instance, a suspected orbital tumor can be diagnosed on neuroimaging, but a biopsy may also be recommended.

A Hertel exophthalmometer can measure and manage the degree of enophthalmos. 

Treatment

Treatment depends on the cause, but almost always includes surgery to rebuild the orbit.

Bibliography

  1. American Academy of Ophthalmology. “The Enophthalmos Syndromes”. Aao.Org, 2022, https://www.aao.org/oculoplastics-center/enophthalmos-syndromes.
  2. Cline, Roy A., and Jack Rootman. “Enophthalmos: a clinical review.” Ophthalmology, vol. 91 no. 91, 3 May 1984, pp. 229-237. https://www.sciencedirect.com/science/article/abs/pii/S0161642084342993, 10.1016/S0161-6420(84)34299-3.
  3. Lando, Leonardo, Marina OS Paiva, and Luciano S. Pereira. “Enophthalmos in silent brain syndrome.” Indian Journal of Ophthalmology 68.11 (2020): 2536. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7774221/, 10.4103%2Fijo.IJO_897_20.
  4. Santos-Longhurst, Adrienne. “Asymmetrical Eyes: Causes and Treatment”. Healthline, 2018, https://www.healthline.com/health/%20asymmetrical-eyes.
  5. Hamedani M, Pournaras JA, Goldblum D. Diagnosis and management of enophthalmos. Surv Ophthalmol. 2007 Sep-Oct;52(5):457-73. doi: 10.1016/j.survophthal.2007.06.009. PMID: 17719369.

Related Terms

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Foveola

is a small zone in the eye responsible for sharp central vision, such as reading and driving. It also allows us to see colors

Accommodation Disorder

also known as accommodative dysfunction, is any problem with the focusing power of the eye

Puncta

play an important role in tear drainage. Puncta can be occluded to treat dry eye disease and may improve symptoms

Canaliculus

is part of the nasolacrimal drainage system, which drains tears from the surface of the eye into the nasal cavity

Vitreous Body

or vitreous humor is the clear, gelatinous extracellular matrix (ECM) structure that fills the posterior part of the eye

Best Corrected Visual Acuity

is the highest quality of vision that a person can have when wearing glasses or contact lenses

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