Retrospective and Comprehensive Evaluation of Posttraumatic Enophthalmos after Intraorbital Fat Injection

Post-traumatic enophthalmos (PE) is characterized by a posteriorly displaced eyeball (enophthalmos), deep superior sulcus (sunken upper eyelid), and bilateral asymmetry. Intraorbital injection of autologous fat has shown potential for correcting enophthalmos, but several limitations remain, such as patient heterogeneity, small sample sizes, non-quantitative assessment methods and a focus solely on enophthalmos. This study aims to assess both enophthalmos and sunken upper eyelids in a homogeneous patient group using quantitative methods.

Forty-three sighted PE eyes were retrospectively analyzed after fat injection. The enophthalmos was assessed by bilateral enophthalmos value difference (BEVD), sunken upper eyelid was assessed by structural similarity index measure (SSIM), and satisfaction survey by a questionnaire. Intra- and post-operative complications were recorded.

The mean follow-up period was 35.0 ± 15.1 months. The BEVD was significantly improved from preoperative 3.8 ± 1.9 mm to post-operative 1.4 ± 1.2 mm. (P < 0.001). No significant correlation was found between fracture type, prior surgery, and BEVD improvement. The SSIM was significantly improved from 0.714 ± 0.119 to 0.803 ± 0.063 (P = 0.003) in 14 eyes with sunken upper eyelid. The patient satisfaction rate reached 83.7%, and satisfaction rate from parents, friends and colleagues were each 83.7%. No severe complications such as embolism or vision loss were observed.

Favorable outcomes in BEVD, SSIM, and patient satisfaction survey following intraorbital autologous fat injection indicate its promising applicability in the treatment of post-traumatic enophthalmos and sunken upper eyelids.