Is it possible to correct enophthalmos 10 years after it developed?

Question

I think i've had enophthalmos in one eye for a long time but in the past few years it's been starting to show a lot more. I think i got it from an injury which was a soccer ball to the eye. Most likely when I was 8-9 and i am now 18. Is it possible that it can still be corrected?

Mark McRae, MD · Answer

Hi there,
Thank you for this excellent question. As a craniofacial trained plastic surgeon I have extensive expertise in surgeries of the eyelids and orbital region. The globe position is a key consideration that is often overlooked in the orbital anatomy. 
Before you go further, you will want to get examined to make sure you do not have any levator ptosis in the right eye. A board certified opthalmologist or plastic surgeon will be able to help you rule out that issue that can contribute to your concern.
Now on to enophthalmos:In 2018 I published the largest series of delayed enophthalmos correction patients with Dr Oleh Antonyshyn in the surgical literature to date. I do feel that I am qualified to give you good advice for your concern. But first for some education. 
What is enophthalmos? 
Enophthalmos is defined as the posterior displacement of the globe in an anteroposterior plane within the orbit
For my plastic surgery residents, I teach them that there are key signs of enophthalmos on physical examination that clinches the diagnosis even before a CT scan is used to identify the bony anatomy and volume differences.
These are deepining of the supratarsal crease (The indent in the upper eyelid), and decreased opening of the palpebral fissure (eye looks smaller as less of it is visible). The most devastating consequence of enophthalmos is double vision (diplopia). As the eye sinks back the muscles have different tensions and the brain cannot always compensate for this so you see double. 
Enophthalmos arises from the relative difference in the bony volume of the orbit, and the contents that are contained within that space.
Think of it as a cup with water. You can be born with a cup that is bigger on one side than the other- this is more common than you think! You can also break the bones and make the space bigger. Trauma can also cause fat that is in the orbit to move out or atrophy and this can also lead to less volume in the orbit, thereby making the eye sink back into the face further.
In your case- it appears that you have an orbital asymmetry where one eye is also higher than the other. Don’t worry you are not abnormal. Start looking at others and you will see that many people have this asymmetry also. This is more specifically classified as a globe dystopia. In terms of exop vs enophthalmos: Relative to the other side your left globe does project further than the right. This can be measured in a physical examination and based on societal norms the eyes can be classified as enop vs exophathalmic.
With all this being said, I would recommend you do nothing unless you currently have a functional limitation such as double vision. 
Since your brain has already compensated for the asymmetry of your globe position from a young age, changing that relationship now has a high chance of giving you double vision and this may be permanent and debilitating. 
Your next steps should you want to pursue this further is to find a qualified board certified plastic surgeon and ophthalmologist. With their help you can make sure you have no medical conditions that are contributing to your globe asymmetry, consider a CT scan or mri to investigate your bony anatomy and soft tissue anatomy. 
Unfortunately based on the state of the surgical art today, I recommend that you avoid surgery. The risk of downgrading your visual function is not worth the improved symmetry you will achieve.
Finally remember that all our faces are asymmetric. Google George Clooney facial asymmetry. He is one of the best looking people in the world but his face is not symmetric at all!
Best regards

Is it possible to correct enophthalmos 10 years after it developed?

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Is it possible to correct enophthalmos 10 years after it developed?

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