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L. Koo, M.P. Hatton, P.A. D. Rubin; Quantification of Enophthalmos . Invest. Ophthalmol. Vis. Sci. 2004;45(13):54.
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Purpose: The ability to detect enophthalmos may identify important clinical conditions, such as sinus disease, orbital fracture, and metastatic breast carcinoma. Little data exist regarding how many millimeters of enophthalmos must be present to be recognized in the clinical setting. Methods: The Massachusetts Eye and Ear Infirmary Oculoplastics and Orbital Surgery imaging database was used to select twelve photographs of patients with enophthalmos from 1 to 8 mm (by Hertel exophthalmometry) as the study group and 12 photographs of patients without enophthalmos as the control group. These photographs were uniformly cropped to include the brows, orbits, and nose in order to standardize the appearance of the photographs. Ophthalmologists, technicians, and support staff were asked to review each of the photographs and to comment on whether the person’s general appearance was "normal" or "abnormal". If they responded "abnormal" they were asked to describe why. Results: 87% of the control patients and 83% of patients with 1–2 mm enophthalmos were identified as "normal". 28% of patients with 3–4 mm enophthalmos were considered "normal" (p<0.001), and 3% of patients with 5–8 mm enophthalmos were considered "normal" (p<0.001). The three study groups were further subdivided. There was no statistical difference between the control, 1 mm, and 2 mm patients (87%, 80%, and 86% "normal" respectively). 42% of 3 mm patients were identified as "normal" (p<0.01). 14% of 4 mm patients were thought to be "normal" (p<0.001). There was a statistical difference between 2 mm vs. 3 mm of enophthalmos (p<0.05) and 3 mm vs. 4 mm (p<0.025). No statistical difference was noted between the patients with measurements of 5 mm and greater. Conclusions: Patients with 2 mm and less of enophthalmos appear as "normal" as control patients. Nearly all patients with 5mm and greater of enophthalmos appear "abnormal". About 40% of patients with 3 mm of enophthalmos were still considered "normal". These data indicate that the point at which enophthalmos becomes clinically detectable lies between 2 mm and 4 mm.
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