Enophthalmos And/or Hypoglobus After Orbital Floor Fracture? (photo)

I am concerned that my eye is displaced after an orbital floor fracture. I had surgery 5+ weeks ago to repair the orbital floor and zygoma. It appears that the injured eye is lower and more posterior than the other. What are my options? If it ends up that my eye is out of position, what is the procedure to correct it? When will I be able to undergo such a procedure, given I just had surgery on the area less than 2 months ago? My left lower eyelid sags from the transconjunctival incision btw.

Doctor Answers 7

Enophthalmos And/or Hypoglobus After Orbital Floor Fracture?

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Best to see an oculoplastic specialist for examination along with CT scan of your orbits. One other thing that can give illusion of the eyeballs look being displaced is if the eyelids are asymmetric. For instance, your left lower eyelid is lower than the right side, which may require eyelid surgery instead of orbit surgery.

Beverly Hills Oculoplastic Surgeon
4.9 out of 5 stars 91 reviews


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Thank you for the question. Based on the photo provided your eye or globe appears to be in the corect position. However, the lower eyelid appears "pulled down" this is called ectropion or scarring of the lower eyelid. Often the lower eyelid will not be able to fully close from the scarring. This can cause a dry and imflamed eye. You should return to your surgeon as soon as possible. They will most likely give you eyedrops and have you massage the eyelid. Ectropion will often require a secondary surgery to correct the scarring.

Lower Eyelid Ectropion Problem After Cheekbone Fracture Repair

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I think you have an isolated lower lid retraction but not a globe displacement issue. Even though it is only 5 weeks after surgery, I think you are going to require an ectropion repair. It is not a question of if but when. If there is no substantial improvement by three months after surgery, then a lid repositioning procedure is justified given the severity of your problem.

Enophthalmos and Lower Eyelid Malposition

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    The correction in these cases is never perfect.  In the absence of double vision, you should wait for several months for resolution of swelling.  The lid should be massaged and nighttime taping instituted as conservative measures for eyelid malposition.

Orbital Floor Fracture

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I agree with previous posters that there is evidence of ectropion which will likely require surgical correction. Although it is best to wait and allow inflammation to subside, earlier intervention is sometimes necessary because of dry eye symptoms.  Unfortunately, even in best case scenarios with an orbital blow out fracture, some degree of orbital volume loss and enophthalmos can occur.  This can be countered with placement of an orbital floor implant.  However, it would be optimal to wait 6 months to a year prior to proceeding.  Additionally, this type of procedure is probably best performed by an ASOPRS trained Occuloplastic Surgeon.

Stephen Prendiville, MD
Fort Myers Facial Plastic Surgeon
4.9 out of 5 stars 103 reviews

Enophthalmos after orbital fracture repair

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I would wait a total of 6 months and consider an orbital floor implant to increase the orbital volume and push the globe up. They come in different thicknesses.

Peter T. Truong, MD
Fresno Oculoplastic Surgeon
4.9 out of 5 stars 42 reviews

You May Also Consider Fillers

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I agree with the other post.  You do have ectropion and enopthalmos.  Depending on the severity of the two issues, you may require surgery and you might want to consider fillers to the cheek area.  Fillers in this area can improve the symmetry of your face and push up your lower lid.  


I hope this helps.  

These answers are for educational purposes and should not be relied upon as a substitute for medical advice you may receive from your physician. If you have a medical emergency, please call 911. These answers do not constitute or initiate a patient/doctor relationship.