Enophthalmic Blind Immobile Eye with Ptosis
This case presents surgery for glioma of the optic nerve
(left eye) without enucleation of the eye, resulting in recession
(enophthalmos) of the globe. Vision was lost when the
optic nerve was severed and the extensive surgery also caused
unilateral loss of all ocular and appendage function.
Beside the immobility of the levator and rectus muscles,
the receded globe caused blepharoptosis (total lid droop).
The surgery induced enophthalmos resulted in upper eyelid
ptosis, depression of orbital fat under the eyebrow and loss
of the upper tarsal lid fold.
Elevation of the upper eyelid shows a hypo-positioned eye.
This is highlighted by the catoptric image (light reflection
on the cornea).
Replacement of orbital volume with a full thickness scleral
ocular prosthesis over the blind eye eliminated enophthalmos,
however, there was still the presence of a ptosis and only
a slight upper tarsal lid fold.
Corrective adjustment for upper eyelid cosmesis was accomplished
by extending the upper periphery of the prosthesis deeper
into the upper fornix. This elevated the lid to a near
normal aperture resulting with an improved upper tarsal lid
This combined photograph shows profile (upper) of the prosthesis
with a normal anterior curvature. The (lower) photograph
shows the adjustment to the prosthesis in clear acrylic.
Note the deviation of the anterior curvature to support and
elevate the upper lid. Also, the thicker anterior posterior
portion along the upper peripheral edge that restored the
upper tarsal lid fold.