Enophthalmos

What is enophthalmos?

Enophthalmos is the term for when your eyes are sunken in. The “en” refers to “in” and “ophthalmos” means eye. The opposite of enophthalmos is exophthalmos (proptosis) of the eyes, also called bulging eyes.

Sunken eyes, or enophthalmos, can be something that you’re born with (congenital), or something that happens to you sometime after birth (acquired). It can happen in one eye (unilateral) or both eyes (bilateral).

There are several reasons why enophthalmos happens. These include dehydration, diseases like Horner’s syndrome and traumatic eye injuries, like those that might occur during motor vehicle or other accidents or during physical fighting (traumatic enophthalmos). Congenital conditions such as silent sinus syndrome can cause enophthalmos. Getting older may also cause enophthalmos (senile enophthalmos).

Who does enophthalmos affect?

Enophthalmos often happens after accidents involving cars, trucks and motorcycles, or after physical fights that result in orbital fractures. These fractures are breaks in the bones that surround the eyes. The condition happens more often in men and people assigned male at birth.

What are the signs and symptoms of enophthalmos?

Signs and symptoms of enophthalmos depend on what caused the condition. They may include:

• Double vision (diplopia).
• Difficulty focusing.
• Asymmetry of facial features, which means that one side of your face doesn’t really match the other side.
• Sagging upper eyelids (ptosis).
• Deep groove (sulcus) in your eyelid.
• Eye dryness.

A healthcare provider may be able to see some of the signs — sagging eyelids, facial asymmetry and misalignment of your eyeballs — just by looking at you.

What causes enophthalmos?

You can have sunken eyes because of many things. The causes generally fall into a few categories.

Changes in the size of the orbit of your eye (socket)

People use the word “orbit” to refer to the actual cage made of bone around your eye. It can also refer to the cage and the contents of the cavity together. If the size of your socket (orbit) changes and becomes bigger, the contents (including your eyeball) can shift position. Your orbit might change in size for a variety of reasons, including:

• Fractures in the bones that surround your eyes, most often breaks in the orbital floor. An orbital blowout fracture is a very serious type of break. Other types of breakages include fractures made by damage to your jaws and face.
• A condition called silent sinus syndrome (SSS), or chronic maxillary sinus atelectasis. The orbital floor gets weaker and curves out because of maxillary sinus disease. This disease refers to the sinus cavities in your cheeks on either side of your nose.
• Missing or deformed parts of facial bones due to other conditions such as neurofibromatosis.
• Bone changes due to aging.

Changes in what your eye socket contains

Your eyes can sink because of changes in the contents of your eye socket. These may include:

• Fat tissue reduction and muscle weakening due to aging. Two examples related to age-related changes have their own names: giant fornix syndrome (GFS) and senile sunken eye syndrome. GFS happens with recurring conjunctivitis (pink eye). Both GFS and senile sunken eye syndrome can cause problems with the surface of your eye.
• Vascular problems.
• Long-term effects of radiation therapy to your head.
• Diseases that cause changes in fat distribution throughout your body, including your face. One of these is Parry-Romberg syndrome, which affects one side of your face. Another is human immunodeficiency virus (HIV).
• Scleroderma, an autoimmune condition that causes tissues to become thick, often in your skin, but also in your kidneys, digestive tract and other parts of your body.
• Trauma, including surgery, to your orbit, even if bones aren’t broken.
• Certain medications that treat glaucoma. There’s a condition called prostaglandin-associated periorbitopathy (PAP) that may not go away even after you stop taking the medication.

Changes in the size of your eye

Sometimes, changes to your eye itself can change its position. These changes include:

• Cancer metastasis (spread beyond the point of origin) locations like your breast, prostate, lung, gastrointestinal tract, skin or parotid gland.
• Severe eye damage from trauma, even without fracturing bones.
• Congenital fibrosis syndrome, a condition in which scarring (fibrosis) happens in both eyes. As the condition is in both eyes (bilateral), it might not be obvious just by looking at you.

How is enophthalmos diagnosed?

In many cases, a healthcare provider can see that you have enophthalmos by looking at you, especially when enophthalmos affects one eye. In addition to taking a medical history, your provider will do an eye examination.

There are also tools and tests that eye care specialists can use to measure whether or not you have enophthalmos, including:

• Exophthalmometry, which measures how far out your eye projects from the orbital socket.
• Computed tomography (CT) scan. This technology combines X-rays and computers to provide three-dimensional images of body parts and tissues.
• Magnetic resonance imaging (MRI) scan. This technology uses a magnet, radio waves and a computer (no radiation) to produce images of body parts and tissues.

How is enophthalmos treated?

Treating enophthalmos involves treating the underlying condition. This could mean:

• Starting or stopping medications.
• Surgery.

Complications related to treatment of enophthalmos

Treating enophthalmos may result in complications, including:

• Worsening symptoms.
• Loss of facial symmetry.
• Loss of vision.
• Double vision.
• Loss of eye movement.

How can I reduce my risk of developing enophthalmos?

One way you can reduce your risk of developing this condition is by lowering your risk of fractures of bones in your eyes and face. Use protective equipment when you should. Drive carefully. Avoid fistfights.

What is the outlook if you have enophthalmos?

Much of the outlook for someone with enophthalmos depends on the cause of the condition. For instance, people who are younger who are treated for fractures or silent sinus syndrome usually have a very good outcome.

When should I see my healthcare provider about enophthalmos?

If you have any type of accident involving blows to your eyes or face, be sure to see a healthcare provider. It’s also important to see your provider if you develop any type of vision issues, including blurred vision or double vision.

What is the difference between enophthalmos and hypoglobus?

Enophthalmos refers to your eyes sinking deeper in your eye socket. Hypoglobus is a downward displacement of your eyeball. Potential causes of either include trauma and silent sinus syndrome.

What is the difference between enophthalmos and anophthalmos?

Anophthalmos means that you’re missing one or both eyes. Enophthalmos means that your eye has shifted position.

What is the difference between enophthalmos and pseudo enophthalmos?

There are conditions that may look like the globe of your eye has been displaced. In some cases, if one eye is more nearsighted (has more myopia) than the other, it may look like one eye has enophthalmos.

A note from Cleveland Clinic

If you have sunken eyes (enophthalmos), your healthcare provider will work with you to find out what’s causing it. This condition may happen because of something obvious, like fractured bones, or because of something that you don’t even realize is happening, like sinus issues. It’s important to see your healthcare provider if you’ve had an accident that results in injury to your face or eyes. And it’s always important to talk to your provider if you notice any type of change in your vision.