Enophthalmos

Enophthalmos is a retracted globe. The most common cause is a blow to the orbit that raises intraorbital pressure, causing the thin roof of the maxillary sinus to fracture (Fig. 5.12). This is called a “blow-out” fracture. Associated signs may include subconjunctival hemorrhage, entrapment of the inferior rectus muscle in the fracture causing restriction of upward gaze, and vertical diplopia (Fig. 5.13). Decreased sensation (hypesthesia) of the cheek is due to infraorbital nerve damage (Fig. 5.14). If diplopia or enophthalmos persists; or if more than 50% of the floor is blown out; a silicone, polyethylene or titanium mesh may be inserted.

Fig. 5.13 Restriction of upward gaze due to blow-out fracture.

Fig. 5.12 Computed tomography (CT) scan of orbital blow-out fracture (Ø).

Fig. 5.14 Test for hypesthesia using 2 paper clips to compare the sensitivity on each side.