Functional indications for enophthalmos repair

Purpose: In general, orbital augmentation to correct enophthalmos is pursue d to prevent or address an aesthetic deformity. In some cases, however, fun ctional deficits may accompany enophthalmos and may serve as an indication for surgical intervention. The authors describe a series of patients with s uch deficits. Methods: A retrospective review at a tertiary health care center of all pat ients with enophthalmos was conducted to identify a subset of cases in whic h the enophthalmos was associated with nonaesthetic, functional deficits th at could not be attributed to muscular or neural dysfunction, or soft tissu e scarring. Results: Six patients with either traumatic enophthalmos (orbital fractures ) or nontraumatic enophthalmos (sinus disease and orbital soft tissue atrop hy) demonstrated nonaesthetic ocular dysfunction, including gaze-evoked dip lopia, eyelid retraction, lagophthalmos, and exposure keratitis. The sympto ms and signs resolved in the three patients who underwent orbital augmentat ion. Conclusions: In some patients with enophthalmos and globe ptosis, globe mal position may alter the underlying eyelid mechanics or extraocular muscle al ignment, resulting in functional as well as aesthetic problems. In these pa tients, restoring the native orbital anatomy through orbital augmentation c an reverse eyelid malposition, ocular surface exposure, and symptomatic dip lopia, avoiding the need for eyelid or strabismus surgery.