Do your eyes look sunken? Let's talk about Enophthalmos!

Have you ever noticed that some people's eyes look a little sunken in, as if they have sunk into their sockets? Maybe you've experienced this yourself, or maybe you've seen someone you know do it. In medicine, this is called enophthalmos . This name may sound a bit serious, but don't worry. Let's talk about it simply, in a way that you can understand. Because this condition can occur for a number of reasons, and there are things you can do about it.

What exactly is Enophthalmos?

Simply put, enophthalmos is when one or both of your eyes sink into, or sink inward, into the eye socket. The "en" in this case means "inside" and the "ophthalmos" means "eye." The other side of this, when the eyes protrude, is called exophthalmos or proptosis . Some people also call it "eyeballs popping out."

This condition of sunken eyes, called enophthalmos, can be congenital or acquired . It can also affect one eye (unilateral) or both eyes (bilateral).

There could be several reasons for this. For example:

• Dehydration is a lack of water in the body.
• Some medical conditions, such as Horner's syndrome .
• Traumatic eye injuries - These can be caused by things like car accidents, fights, or orbital fractures. This is called traumatic enophthalmos .
• Congenital conditions like Silent Sinus Syndrome .
• With age (senile enophthalmos), the eyes can sometimes become slightly sunken.

Who is most affected by Enophthalmos?

This condition is most often seen in people who have been involved in motor vehicle accidents (cars, trucks, motorcycles), or in those who have suffered orbital fractures from blows to the face or fights. The orbital bone is the protective bone framework around the eye. Statistically, this condition affects men slightly more than women.

What are the symptoms of enophthalmos?

If you have enophthalmos, the symptoms may vary depending on the cause. However, there are some common symptoms that you may see:

• Double vision (Diplopia): Seeing two things at once. This is really annoying.
• Difficulty focusing: It takes a while to see clearly, or you may not see clearly at all.
• Asymmetry of facial features: This means that one side of your face doesn't match the other exactly. This can happen when your eyes are sunken.
• Drooping of the upper eyelid (Ptosis): Can make you look sleepy.
• Deep sulcus : A deep groove that appears between the upper eyelid and the eyebrow.
• Dry eyes: Feeling like your eyes are not getting enough tears, redness, and inflammation.

Sometimes a doctor can recognize some of these signs (sagging upper eyelids, facial asymmetry, sunken eyes) as soon as they see you.

Why does enophthalmos occur? What are the causes?

There are many possible causes of sunken eyes, or enophthalmos. These causes can be divided into several main categories.

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

When we say "orbit," we mean the bony socket that surrounds your eye. Sometimes, the socket and everything inside it (including the eyeball) are collectively called the "orbit." So, if the size of this eye socket changes and gets bigger, the position of the things inside can change. There are several reasons why the size of the eye socket can change:

• Fractures around your eye: This is the most common cause. Specifically, fractures of the bones under the eye socket (orbital floor fracture). An orbital blowout fracture is a very severe type of fracture. It can also occur due to damage to the jaw and other bones in the face.
• Silent Sinus Syndrome (SSS) or chronic maxillary sinus atelectasis : This is a condition in which the lower part of the eye socket weakens and collapses inward due to a disease of the maxillary sinuses, the air cavities located in the cheeks on either side of the nose.
• Other conditions, such as neurofibromatosis, can cause facial bone loss or deformity.
• Changes in bones with aging: Our bones also change over time.

2. Changes in what's inside your eye socket

Sometimes, sunken eyes can occur due to changes in the fatty tissue and muscles inside the eye socket, rather than problems with the bones. Examples:

• Aging causes atrophy and muscle weakness: Two conditions that are caused by these age-related changes even have their own names: Giant Fornix Syndrome (GFS) and senile sunken eye syndrome . GFS is associated with frequent conjunctivitis (an eye disease). Both conditions can also cause problems with the surface of the eye.
• Vascular problems.
• Long-term effects of radiation therapy to the head.
• Diseases that change the pattern of fat distribution throughout the body, especially in the face: One example of this is Parry-Romberg syndrome , which affects only one side of the face. Another example is the human immunodeficiency virus (HIV) .
• Scleroderma: This is an autoimmune condition that causes thickening of various tissues in the body, such as the skin, kidneys, and digestive system.
• Injuries or surgery to the eye socket (even if the bone is not broken): Sometimes, even if the bone is not broken, an injury or surgery to the eye socket can cause the eye to sink in.
• Some medications used to treat glaucoma: There is a condition called prostaglandin-associated periorbitopathy (PAP) . This may not completely resolve even after stopping the medication.

3. Changes in the size of your eyes

Sometimes, the position of the eyes can change due to changes in the eye itself, such as the eye becoming smaller.

• Cancer metastasis: Cancer that has spread to the eye from a location such as the breast, prostate, lung, gastrointestinal system, skin, or parotid gland.
• Severe eye damage from an accident (even without a broken bone).
• Congenital fibrosis syndrome: This is a condition that is present at birth. It causes scarring (fibrosis) in both eyes. Because it affects both eyes (bilateral), this difference may not be noticeable at first glance.

How to diagnose Enophthalmos? (Diagnosis)

In most cases, especially if only one eye is affected by enophthalmos, a doctor can diagnose the condition as soon as they see you. In addition, they will ask about your medical history and perform a complete eye examination .

Also, there are special instruments and tests that ophthalmologists use to accurately measure whether you have enophthalmos or not:

• Exophthalmometry: This measures how far your eye protrudes (protrudes) or sinks (sinks) out of the eye socket.
• Computed Tomography (CT) scan: This technique combines X-rays and computers to create three-dimensional (3D) images of body parts and tissues. This can provide a better understanding of the condition of the bones and tissues inside the eye socket.
• Magnetic Resonance Imaging (MRI scan): This technique uses a magnet, radio waves, and a computer (no radiation) to produce detailed images of body parts and tissues. It can provide particularly good detail of soft tissues.

Remember, you may not need to have all of these tests. Your doctor will decide which tests are appropriate based on your condition.

How is Enophthalmos treated?

Treating enophthalmos really means treating the underlying cause. So, the treatment varies depending on the cause.

• Starting or stopping medication: Sometimes this is due to a medical condition, which requires starting medication. Or, if it's something like glaucoma medication, your doctor may advise stopping or changing that medication.
• Surgery: If it's due to something like an orbital fracture, surgery may be needed to repair it. Sometimes surgery is also done to correct the volume of the eye socket or to provide support for the eye.

Are there any complications related to the treatment?

Yes, sometimes complications can occur after treatment for enophthalmos. It doesn't happen to everyone, but it's good to know:

• Symptoms getting worse.
• Loss of facial symmetry.
• Loss of vision (very rare).
• Double vision (Diplopia).
• Decreased or loss of the ability to move the eyes.

This is why it is important to seek proper treatment from a specialist.

How can you reduce the risk of enophthalmos?

One thing you can do to reduce your risk of this condition is to protect yourself from fractures to your eyes and facial bones.

• Use safety equipment: Wear appropriate safety glasses and helmets when playing sports or engaging in any risky activities.
• Drive carefully: Car accidents are a leading cause of facial injuries.
• Avoid fights: Blows to the face can damage the eye socket.

What is the outlook for recovery for someone with enophthalmos?

The outlook for recovery for someone with enophthalmos depends largely on the underlying cause. For example, treatment for a fracture or silent sinus syndrome at a young age usually yields very good results. However, if the cause is more complex, treatment may be more complex and recovery times may vary.

When should I see a doctor?

If you have an accident that causes a blow to your eyes or face, it is important to see a doctor. It is also important to talk to a doctor if you notice any changes in your vision (e.g. blurred vision, double vision) or if you feel like your eyes are sunken in. The sooner you find the cause, the easier it is to treat.

What is the difference between Enophthalmos and Hypoglobus?

Enophthalmos is when your eyeballs sink into their sockets. Hypoglobus is when your eyeballs move downwards. Both can be caused by trauma and Silent Sinus Syndrome.

What is the difference between Enophthalmos and Anophthalmos?

Anophthalmos is the absence of one or both eyes at birth. Enophthalmos is the displacement of the eye , causing it to sink inward. These are two completely different conditions.

What is the difference between Enophthalmos and Pseudoenophthalmos?

Sometimes, there can be a condition where the eye appears sunken without actually being sunken. This is called pseudo-enophthalmos ( pseudo means "false"). For example, if one eye is much more myopic (nearsighted) than the other, that eye may appear to be sunken. But the eye is not actually sunken.

Finally, things to remember (Take-Home Message)

If you have sunken eyes (enophthalmos), your doctor can help you find the cause. This condition may be caused by something obvious, like a fracture, or it may be something you don't realize is happening, like a sinus problem.

The most important thing is to seek medical advice if you have an accident with your face or eyes. Also, if you notice any changes in your vision, talk to your doctor about it. Early diagnosis and treatment can prevent many problems. Don't worry, there are solutions to everything!

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