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Timothy J. Mcculley - One of the best experts on this subject based on the ideXlab platform.

  • sunken eyes sagging brain syndrome bilateral Enophthalmos from chronic intracranial hypotension
    Ophthalmology, 2011
    Co-Authors: Thomas N. Hwang, Soraya Rofagha, Jonathan C. Horton, W F Hoyt, Michael W Mcdermott, Timothy J. Mcculley
    Abstract:

    Purpose To explain the mechanism for acquired Enophthalmos after ventriculoperitoneal shunting (VPS). Design Case series and a case-control study. Participants and Controls Four study patients with bilateral Enophthalmos after VPS and 10 control subjects. Methods Case description of 4 study patients. Calculated orbital volumes for 2 study patients were compared with controls using the Wilcoxon rank-sum test. Main Outcome Measures Exophthalmometry measurements and total orbital and fat volumes. Results Patient 1 is a 25-year-old man who presented with progressive Enophthalmos 3 years after VPS for traumatic intracranial bleeding. Imaging demonstrated upward expansion of the orbital roof and evidence of intracranial hypotension. The intracranial pressure (ICP) was 20 mm H 2 O. The Enophthalmos improved after shunt revision. Patient 2 is a 19-year-old man who presented with progressive Enophthalmos 18 months after VPS for traumatic intracranial hemorrhage. Patient 3 is a 38-year-old woman who presented with bilateral Enophthalmos 15 years after VPS after a ruptured aneurysm. Imaging showed orbital expansion. Patient 4 is a 16-year-old man who presented with severe Enophthalmos 5 years after a VPS for aneurysm-related hemorrhage. Imaging demonstrated orbital enlargement and findings of intracranial hypotension. Intracranial pressure ranged between −200 and 0 mm H 2 O. Shunt revision improved the Enophthalmos. Total orbital volumes were significantly greater in the study patients than in the controls. Control subjects (5 male, 5 female, ages 23–45 years) had an average right orbital volume of 24.6±3.3 cm 3 (n = 10). In comparison, the right orbital volumes of patients 1 and 3 were 32.6 and 32.1 cm 3 . Similar results were found for the left orbits (23.9±2.7 cm 3 [control average] vs. 35.9 and 32.6 cm 3 ). In patient 1, the post-shunt volumes increased 14% (right) and 23% (left) from pre-shunt volumes. In contrast, orbital fat volume was not statistically significantly different between the control group and enophthalmic patients (right orbit control mean 7.94±3.1 cm 3 [n = 10] vs. 7.9 and 9.8 cm 3 ; left orbit control mean 7.88+3.1 cm 3 vs. 9.2 and 10.0 cm 3 ). Conclusions Enophthalmos after VPS results primarily from chronic intracranial hypotension. Low ICP causes expansion of orbital volume with no fat atrophy. In such patients, shunt revision with a pressure-regulating valve to correct intracranial hypotension should be considered. Financial Disclosure(s) The author(s) have no proprietary or commercial interest in any materials discussed in this article.

  • Sunken eyes, sagging brain syndrome: Bilateral Enophthalmos from chronic intracranial hypotension
    Ophthalmology, 2011
    Co-Authors: Thomas N. Hwang, Soraya Rofagha, Jonathan C. Horton, W F Hoyt, Michael W Mcdermott, Timothy J. Mcculley
    Abstract:

    Purpose: To explain the mechanism for acquired Enophthalmos after ventriculoperitoneal shunting (VPS). Design: Case series and a case-control study. Participants and Controls: Four study patients with bilateral Enophthalmos after VPS and 10 control subjects. Methods: Case description of 4 study patients. Calculated orbital volumes for 2 study patients were compared with controls using the Wilcoxon rank-sum test. Main Outcome Measures: Exophthalmometry measurements and total orbital and fat volumes. Results: Patient 1 is a 25-year-old man who presented with progressive Enophthalmos 3 years after VPS for traumatic intracranial bleeding. Imaging demonstrated upward expansion of the orbital roof and evidence of intracranial hypotension. The intracranial pressure (ICP) was 20 mm H 2O. The Enophthalmos improved after shunt revision. Patient 2 is a 19-year-old man who presented with progressive Enophthalmos 18 months after VPS for traumatic intracranial hemorrhage. Patient 3 is a 38-year-old woman who presented with bilateral Enophthalmos 15 years after VPS after a ruptured aneurysm. Imaging showed orbital expansion. Patient 4 is a 16-year-old man who presented with severe Enophthalmos 5 years after a VPS for aneurysm-related hemorrhage. Imaging demonstrated orbital enlargement and findings of intracranial hypotension. Intracranial pressure ranged between -200 and 0 mm H 2O. Shunt revision improved the Enophthalmos. Total orbital volumes were significantly greater in the study patients than in the controls. Control subjects (5 male, 5 female, ages 2345 years) had an average right orbital volume of 24.6±3.3 cm 3 (n = 10). In comparison, the right orbital volumes of patients 1 and 3 were 32.6 and 32.1 cm 3. Similar results were found for the left orbits (23.9±2.7 cm 3 [control average] vs. 35.9 and 32.6 cm 3). In patient 1, the post-shunt volumes increased 14% (right) and 23% (left) from pre-shunt volumes. In contrast, orbital fat volume was not statistically significantly different between the control group and enophthalmic patients (right orbit control mean 7.94±3.1 cm 3 [n = 10] vs. 7.9 and 9.8 cm 3; left orbit control mean 7.88+3.1 cm 3 vs. 9.2 and 10.0 cm 3). Conclusions: Enophthalmos after VPS results primarily from chronic intracranial hypotension. Low ICP causes expansion of orbital volume with no fat atrophy. In such patients, shunt revision with a pressure-regulating valve to correct intracranial hypotension should be considered. Financial Disclosure(s): The author(s) have no proprietary or commercial interest in any materials discussed in this article. © 2011 American Academy of Ophthalmology.

Thomas N. Hwang - One of the best experts on this subject based on the ideXlab platform.

  • sunken eyes sagging brain syndrome bilateral Enophthalmos from chronic intracranial hypotension
    Ophthalmology, 2011
    Co-Authors: Thomas N. Hwang, Soraya Rofagha, Jonathan C. Horton, W F Hoyt, Michael W Mcdermott, Timothy J. Mcculley
    Abstract:

    Purpose To explain the mechanism for acquired Enophthalmos after ventriculoperitoneal shunting (VPS). Design Case series and a case-control study. Participants and Controls Four study patients with bilateral Enophthalmos after VPS and 10 control subjects. Methods Case description of 4 study patients. Calculated orbital volumes for 2 study patients were compared with controls using the Wilcoxon rank-sum test. Main Outcome Measures Exophthalmometry measurements and total orbital and fat volumes. Results Patient 1 is a 25-year-old man who presented with progressive Enophthalmos 3 years after VPS for traumatic intracranial bleeding. Imaging demonstrated upward expansion of the orbital roof and evidence of intracranial hypotension. The intracranial pressure (ICP) was 20 mm H 2 O. The Enophthalmos improved after shunt revision. Patient 2 is a 19-year-old man who presented with progressive Enophthalmos 18 months after VPS for traumatic intracranial hemorrhage. Patient 3 is a 38-year-old woman who presented with bilateral Enophthalmos 15 years after VPS after a ruptured aneurysm. Imaging showed orbital expansion. Patient 4 is a 16-year-old man who presented with severe Enophthalmos 5 years after a VPS for aneurysm-related hemorrhage. Imaging demonstrated orbital enlargement and findings of intracranial hypotension. Intracranial pressure ranged between −200 and 0 mm H 2 O. Shunt revision improved the Enophthalmos. Total orbital volumes were significantly greater in the study patients than in the controls. Control subjects (5 male, 5 female, ages 23–45 years) had an average right orbital volume of 24.6±3.3 cm 3 (n = 10). In comparison, the right orbital volumes of patients 1 and 3 were 32.6 and 32.1 cm 3 . Similar results were found for the left orbits (23.9±2.7 cm 3 [control average] vs. 35.9 and 32.6 cm 3 ). In patient 1, the post-shunt volumes increased 14% (right) and 23% (left) from pre-shunt volumes. In contrast, orbital fat volume was not statistically significantly different between the control group and enophthalmic patients (right orbit control mean 7.94±3.1 cm 3 [n = 10] vs. 7.9 and 9.8 cm 3 ; left orbit control mean 7.88+3.1 cm 3 vs. 9.2 and 10.0 cm 3 ). Conclusions Enophthalmos after VPS results primarily from chronic intracranial hypotension. Low ICP causes expansion of orbital volume with no fat atrophy. In such patients, shunt revision with a pressure-regulating valve to correct intracranial hypotension should be considered. Financial Disclosure(s) The author(s) have no proprietary or commercial interest in any materials discussed in this article.

  • Sunken eyes, sagging brain syndrome: Bilateral Enophthalmos from chronic intracranial hypotension
    Ophthalmology, 2011
    Co-Authors: Thomas N. Hwang, Soraya Rofagha, Jonathan C. Horton, W F Hoyt, Michael W Mcdermott, Timothy J. Mcculley
    Abstract:

    Purpose: To explain the mechanism for acquired Enophthalmos after ventriculoperitoneal shunting (VPS). Design: Case series and a case-control study. Participants and Controls: Four study patients with bilateral Enophthalmos after VPS and 10 control subjects. Methods: Case description of 4 study patients. Calculated orbital volumes for 2 study patients were compared with controls using the Wilcoxon rank-sum test. Main Outcome Measures: Exophthalmometry measurements and total orbital and fat volumes. Results: Patient 1 is a 25-year-old man who presented with progressive Enophthalmos 3 years after VPS for traumatic intracranial bleeding. Imaging demonstrated upward expansion of the orbital roof and evidence of intracranial hypotension. The intracranial pressure (ICP) was 20 mm H 2O. The Enophthalmos improved after shunt revision. Patient 2 is a 19-year-old man who presented with progressive Enophthalmos 18 months after VPS for traumatic intracranial hemorrhage. Patient 3 is a 38-year-old woman who presented with bilateral Enophthalmos 15 years after VPS after a ruptured aneurysm. Imaging showed orbital expansion. Patient 4 is a 16-year-old man who presented with severe Enophthalmos 5 years after a VPS for aneurysm-related hemorrhage. Imaging demonstrated orbital enlargement and findings of intracranial hypotension. Intracranial pressure ranged between -200 and 0 mm H 2O. Shunt revision improved the Enophthalmos. Total orbital volumes were significantly greater in the study patients than in the controls. Control subjects (5 male, 5 female, ages 2345 years) had an average right orbital volume of 24.6±3.3 cm 3 (n = 10). In comparison, the right orbital volumes of patients 1 and 3 were 32.6 and 32.1 cm 3. Similar results were found for the left orbits (23.9±2.7 cm 3 [control average] vs. 35.9 and 32.6 cm 3). In patient 1, the post-shunt volumes increased 14% (right) and 23% (left) from pre-shunt volumes. In contrast, orbital fat volume was not statistically significantly different between the control group and enophthalmic patients (right orbit control mean 7.94±3.1 cm 3 [n = 10] vs. 7.9 and 9.8 cm 3; left orbit control mean 7.88+3.1 cm 3 vs. 9.2 and 10.0 cm 3). Conclusions: Enophthalmos after VPS results primarily from chronic intracranial hypotension. Low ICP causes expansion of orbital volume with no fat atrophy. In such patients, shunt revision with a pressure-regulating valve to correct intracranial hypotension should be considered. Financial Disclosure(s): The author(s) have no proprietary or commercial interest in any materials discussed in this article. © 2011 American Academy of Ophthalmology.

Jonathan C. Horton - One of the best experts on this subject based on the ideXlab platform.

  • extraocular muscle dynamics in diplopia from Enophthalmos
    Strabismus, 2011
    Co-Authors: Michael K Yoon, John R Economides, Jonathan C. Horton
    Abstract:

    The mechanism of diplopia from Enophthalmos is not well understood. We describe a 55-year-old man who underwent a left transorbital craniotomy for clipping of a basilar aneurysm. The lateral orbital wall was not reconstructed properly, resulting in 8 mm of left Enophthalmos. Months after surgery the patient developed diplopia with ocular excursions, although he remained orthotropic in primary gaze. The left eye was limited in elevation, adduction, and abduction. These findings were confirmed by eye movement recordings, which showed ocular separation increasing with gaze eccentricity. A CT scan demonstrated a defect in the sphenoid and frontal bones, profound Enophthalmos, and shortening of the rectus muscles. Slack in the extraocular muscles reduced the force generated by each muscle, causing diplopia with ocular rotation. This case under scores the value of careful orbital wall reconstruction after orbitotomy and suggests a mechanism for diplopia produced by postoperative Enophthalmos.

  • sunken eyes sagging brain syndrome bilateral Enophthalmos from chronic intracranial hypotension
    Ophthalmology, 2011
    Co-Authors: Thomas N. Hwang, Soraya Rofagha, Jonathan C. Horton, W F Hoyt, Michael W Mcdermott, Timothy J. Mcculley
    Abstract:

    Purpose To explain the mechanism for acquired Enophthalmos after ventriculoperitoneal shunting (VPS). Design Case series and a case-control study. Participants and Controls Four study patients with bilateral Enophthalmos after VPS and 10 control subjects. Methods Case description of 4 study patients. Calculated orbital volumes for 2 study patients were compared with controls using the Wilcoxon rank-sum test. Main Outcome Measures Exophthalmometry measurements and total orbital and fat volumes. Results Patient 1 is a 25-year-old man who presented with progressive Enophthalmos 3 years after VPS for traumatic intracranial bleeding. Imaging demonstrated upward expansion of the orbital roof and evidence of intracranial hypotension. The intracranial pressure (ICP) was 20 mm H 2 O. The Enophthalmos improved after shunt revision. Patient 2 is a 19-year-old man who presented with progressive Enophthalmos 18 months after VPS for traumatic intracranial hemorrhage. Patient 3 is a 38-year-old woman who presented with bilateral Enophthalmos 15 years after VPS after a ruptured aneurysm. Imaging showed orbital expansion. Patient 4 is a 16-year-old man who presented with severe Enophthalmos 5 years after a VPS for aneurysm-related hemorrhage. Imaging demonstrated orbital enlargement and findings of intracranial hypotension. Intracranial pressure ranged between −200 and 0 mm H 2 O. Shunt revision improved the Enophthalmos. Total orbital volumes were significantly greater in the study patients than in the controls. Control subjects (5 male, 5 female, ages 23–45 years) had an average right orbital volume of 24.6±3.3 cm 3 (n = 10). In comparison, the right orbital volumes of patients 1 and 3 were 32.6 and 32.1 cm 3 . Similar results were found for the left orbits (23.9±2.7 cm 3 [control average] vs. 35.9 and 32.6 cm 3 ). In patient 1, the post-shunt volumes increased 14% (right) and 23% (left) from pre-shunt volumes. In contrast, orbital fat volume was not statistically significantly different between the control group and enophthalmic patients (right orbit control mean 7.94±3.1 cm 3 [n = 10] vs. 7.9 and 9.8 cm 3 ; left orbit control mean 7.88+3.1 cm 3 vs. 9.2 and 10.0 cm 3 ). Conclusions Enophthalmos after VPS results primarily from chronic intracranial hypotension. Low ICP causes expansion of orbital volume with no fat atrophy. In such patients, shunt revision with a pressure-regulating valve to correct intracranial hypotension should be considered. Financial Disclosure(s) The author(s) have no proprietary or commercial interest in any materials discussed in this article.

  • Sunken eyes, sagging brain syndrome: Bilateral Enophthalmos from chronic intracranial hypotension
    Ophthalmology, 2011
    Co-Authors: Thomas N. Hwang, Soraya Rofagha, Jonathan C. Horton, W F Hoyt, Michael W Mcdermott, Timothy J. Mcculley
    Abstract:

    Purpose: To explain the mechanism for acquired Enophthalmos after ventriculoperitoneal shunting (VPS). Design: Case series and a case-control study. Participants and Controls: Four study patients with bilateral Enophthalmos after VPS and 10 control subjects. Methods: Case description of 4 study patients. Calculated orbital volumes for 2 study patients were compared with controls using the Wilcoxon rank-sum test. Main Outcome Measures: Exophthalmometry measurements and total orbital and fat volumes. Results: Patient 1 is a 25-year-old man who presented with progressive Enophthalmos 3 years after VPS for traumatic intracranial bleeding. Imaging demonstrated upward expansion of the orbital roof and evidence of intracranial hypotension. The intracranial pressure (ICP) was 20 mm H 2O. The Enophthalmos improved after shunt revision. Patient 2 is a 19-year-old man who presented with progressive Enophthalmos 18 months after VPS for traumatic intracranial hemorrhage. Patient 3 is a 38-year-old woman who presented with bilateral Enophthalmos 15 years after VPS after a ruptured aneurysm. Imaging showed orbital expansion. Patient 4 is a 16-year-old man who presented with severe Enophthalmos 5 years after a VPS for aneurysm-related hemorrhage. Imaging demonstrated orbital enlargement and findings of intracranial hypotension. Intracranial pressure ranged between -200 and 0 mm H 2O. Shunt revision improved the Enophthalmos. Total orbital volumes were significantly greater in the study patients than in the controls. Control subjects (5 male, 5 female, ages 2345 years) had an average right orbital volume of 24.6±3.3 cm 3 (n = 10). In comparison, the right orbital volumes of patients 1 and 3 were 32.6 and 32.1 cm 3. Similar results were found for the left orbits (23.9±2.7 cm 3 [control average] vs. 35.9 and 32.6 cm 3). In patient 1, the post-shunt volumes increased 14% (right) and 23% (left) from pre-shunt volumes. In contrast, orbital fat volume was not statistically significantly different between the control group and enophthalmic patients (right orbit control mean 7.94±3.1 cm 3 [n = 10] vs. 7.9 and 9.8 cm 3; left orbit control mean 7.88+3.1 cm 3 vs. 9.2 and 10.0 cm 3). Conclusions: Enophthalmos after VPS results primarily from chronic intracranial hypotension. Low ICP causes expansion of orbital volume with no fat atrophy. In such patients, shunt revision with a pressure-regulating valve to correct intracranial hypotension should be considered. Financial Disclosure(s): The author(s) have no proprietary or commercial interest in any materials discussed in this article. © 2011 American Academy of Ophthalmology.

Michael W Mcdermott - One of the best experts on this subject based on the ideXlab platform.

  • sunken eyes sagging brain syndrome bilateral Enophthalmos from chronic intracranial hypotension
    Ophthalmology, 2011
    Co-Authors: Thomas N. Hwang, Soraya Rofagha, Jonathan C. Horton, W F Hoyt, Michael W Mcdermott, Timothy J. Mcculley
    Abstract:

    Purpose To explain the mechanism for acquired Enophthalmos after ventriculoperitoneal shunting (VPS). Design Case series and a case-control study. Participants and Controls Four study patients with bilateral Enophthalmos after VPS and 10 control subjects. Methods Case description of 4 study patients. Calculated orbital volumes for 2 study patients were compared with controls using the Wilcoxon rank-sum test. Main Outcome Measures Exophthalmometry measurements and total orbital and fat volumes. Results Patient 1 is a 25-year-old man who presented with progressive Enophthalmos 3 years after VPS for traumatic intracranial bleeding. Imaging demonstrated upward expansion of the orbital roof and evidence of intracranial hypotension. The intracranial pressure (ICP) was 20 mm H 2 O. The Enophthalmos improved after shunt revision. Patient 2 is a 19-year-old man who presented with progressive Enophthalmos 18 months after VPS for traumatic intracranial hemorrhage. Patient 3 is a 38-year-old woman who presented with bilateral Enophthalmos 15 years after VPS after a ruptured aneurysm. Imaging showed orbital expansion. Patient 4 is a 16-year-old man who presented with severe Enophthalmos 5 years after a VPS for aneurysm-related hemorrhage. Imaging demonstrated orbital enlargement and findings of intracranial hypotension. Intracranial pressure ranged between −200 and 0 mm H 2 O. Shunt revision improved the Enophthalmos. Total orbital volumes were significantly greater in the study patients than in the controls. Control subjects (5 male, 5 female, ages 23–45 years) had an average right orbital volume of 24.6±3.3 cm 3 (n = 10). In comparison, the right orbital volumes of patients 1 and 3 were 32.6 and 32.1 cm 3 . Similar results were found for the left orbits (23.9±2.7 cm 3 [control average] vs. 35.9 and 32.6 cm 3 ). In patient 1, the post-shunt volumes increased 14% (right) and 23% (left) from pre-shunt volumes. In contrast, orbital fat volume was not statistically significantly different between the control group and enophthalmic patients (right orbit control mean 7.94±3.1 cm 3 [n = 10] vs. 7.9 and 9.8 cm 3 ; left orbit control mean 7.88+3.1 cm 3 vs. 9.2 and 10.0 cm 3 ). Conclusions Enophthalmos after VPS results primarily from chronic intracranial hypotension. Low ICP causes expansion of orbital volume with no fat atrophy. In such patients, shunt revision with a pressure-regulating valve to correct intracranial hypotension should be considered. Financial Disclosure(s) The author(s) have no proprietary or commercial interest in any materials discussed in this article.

  • Sunken eyes, sagging brain syndrome: Bilateral Enophthalmos from chronic intracranial hypotension
    Ophthalmology, 2011
    Co-Authors: Thomas N. Hwang, Soraya Rofagha, Jonathan C. Horton, W F Hoyt, Michael W Mcdermott, Timothy J. Mcculley
    Abstract:

    Purpose: To explain the mechanism for acquired Enophthalmos after ventriculoperitoneal shunting (VPS). Design: Case series and a case-control study. Participants and Controls: Four study patients with bilateral Enophthalmos after VPS and 10 control subjects. Methods: Case description of 4 study patients. Calculated orbital volumes for 2 study patients were compared with controls using the Wilcoxon rank-sum test. Main Outcome Measures: Exophthalmometry measurements and total orbital and fat volumes. Results: Patient 1 is a 25-year-old man who presented with progressive Enophthalmos 3 years after VPS for traumatic intracranial bleeding. Imaging demonstrated upward expansion of the orbital roof and evidence of intracranial hypotension. The intracranial pressure (ICP) was 20 mm H 2O. The Enophthalmos improved after shunt revision. Patient 2 is a 19-year-old man who presented with progressive Enophthalmos 18 months after VPS for traumatic intracranial hemorrhage. Patient 3 is a 38-year-old woman who presented with bilateral Enophthalmos 15 years after VPS after a ruptured aneurysm. Imaging showed orbital expansion. Patient 4 is a 16-year-old man who presented with severe Enophthalmos 5 years after a VPS for aneurysm-related hemorrhage. Imaging demonstrated orbital enlargement and findings of intracranial hypotension. Intracranial pressure ranged between -200 and 0 mm H 2O. Shunt revision improved the Enophthalmos. Total orbital volumes were significantly greater in the study patients than in the controls. Control subjects (5 male, 5 female, ages 2345 years) had an average right orbital volume of 24.6±3.3 cm 3 (n = 10). In comparison, the right orbital volumes of patients 1 and 3 were 32.6 and 32.1 cm 3. Similar results were found for the left orbits (23.9±2.7 cm 3 [control average] vs. 35.9 and 32.6 cm 3). In patient 1, the post-shunt volumes increased 14% (right) and 23% (left) from pre-shunt volumes. In contrast, orbital fat volume was not statistically significantly different between the control group and enophthalmic patients (right orbit control mean 7.94±3.1 cm 3 [n = 10] vs. 7.9 and 9.8 cm 3; left orbit control mean 7.88+3.1 cm 3 vs. 9.2 and 10.0 cm 3). Conclusions: Enophthalmos after VPS results primarily from chronic intracranial hypotension. Low ICP causes expansion of orbital volume with no fat atrophy. In such patients, shunt revision with a pressure-regulating valve to correct intracranial hypotension should be considered. Financial Disclosure(s): The author(s) have no proprietary or commercial interest in any materials discussed in this article. © 2011 American Academy of Ophthalmology.

W F Hoyt - One of the best experts on this subject based on the ideXlab platform.

  • sunken eyes sagging brain syndrome bilateral Enophthalmos from chronic intracranial hypotension
    Ophthalmology, 2011
    Co-Authors: Thomas N. Hwang, Soraya Rofagha, Jonathan C. Horton, W F Hoyt, Michael W Mcdermott, Timothy J. Mcculley
    Abstract:

    Purpose To explain the mechanism for acquired Enophthalmos after ventriculoperitoneal shunting (VPS). Design Case series and a case-control study. Participants and Controls Four study patients with bilateral Enophthalmos after VPS and 10 control subjects. Methods Case description of 4 study patients. Calculated orbital volumes for 2 study patients were compared with controls using the Wilcoxon rank-sum test. Main Outcome Measures Exophthalmometry measurements and total orbital and fat volumes. Results Patient 1 is a 25-year-old man who presented with progressive Enophthalmos 3 years after VPS for traumatic intracranial bleeding. Imaging demonstrated upward expansion of the orbital roof and evidence of intracranial hypotension. The intracranial pressure (ICP) was 20 mm H 2 O. The Enophthalmos improved after shunt revision. Patient 2 is a 19-year-old man who presented with progressive Enophthalmos 18 months after VPS for traumatic intracranial hemorrhage. Patient 3 is a 38-year-old woman who presented with bilateral Enophthalmos 15 years after VPS after a ruptured aneurysm. Imaging showed orbital expansion. Patient 4 is a 16-year-old man who presented with severe Enophthalmos 5 years after a VPS for aneurysm-related hemorrhage. Imaging demonstrated orbital enlargement and findings of intracranial hypotension. Intracranial pressure ranged between −200 and 0 mm H 2 O. Shunt revision improved the Enophthalmos. Total orbital volumes were significantly greater in the study patients than in the controls. Control subjects (5 male, 5 female, ages 23–45 years) had an average right orbital volume of 24.6±3.3 cm 3 (n = 10). In comparison, the right orbital volumes of patients 1 and 3 were 32.6 and 32.1 cm 3 . Similar results were found for the left orbits (23.9±2.7 cm 3 [control average] vs. 35.9 and 32.6 cm 3 ). In patient 1, the post-shunt volumes increased 14% (right) and 23% (left) from pre-shunt volumes. In contrast, orbital fat volume was not statistically significantly different between the control group and enophthalmic patients (right orbit control mean 7.94±3.1 cm 3 [n = 10] vs. 7.9 and 9.8 cm 3 ; left orbit control mean 7.88+3.1 cm 3 vs. 9.2 and 10.0 cm 3 ). Conclusions Enophthalmos after VPS results primarily from chronic intracranial hypotension. Low ICP causes expansion of orbital volume with no fat atrophy. In such patients, shunt revision with a pressure-regulating valve to correct intracranial hypotension should be considered. Financial Disclosure(s) The author(s) have no proprietary or commercial interest in any materials discussed in this article.

  • Sunken eyes, sagging brain syndrome: Bilateral Enophthalmos from chronic intracranial hypotension
    Ophthalmology, 2011
    Co-Authors: Thomas N. Hwang, Soraya Rofagha, Jonathan C. Horton, W F Hoyt, Michael W Mcdermott, Timothy J. Mcculley
    Abstract:

    Purpose: To explain the mechanism for acquired Enophthalmos after ventriculoperitoneal shunting (VPS). Design: Case series and a case-control study. Participants and Controls: Four study patients with bilateral Enophthalmos after VPS and 10 control subjects. Methods: Case description of 4 study patients. Calculated orbital volumes for 2 study patients were compared with controls using the Wilcoxon rank-sum test. Main Outcome Measures: Exophthalmometry measurements and total orbital and fat volumes. Results: Patient 1 is a 25-year-old man who presented with progressive Enophthalmos 3 years after VPS for traumatic intracranial bleeding. Imaging demonstrated upward expansion of the orbital roof and evidence of intracranial hypotension. The intracranial pressure (ICP) was 20 mm H 2O. The Enophthalmos improved after shunt revision. Patient 2 is a 19-year-old man who presented with progressive Enophthalmos 18 months after VPS for traumatic intracranial hemorrhage. Patient 3 is a 38-year-old woman who presented with bilateral Enophthalmos 15 years after VPS after a ruptured aneurysm. Imaging showed orbital expansion. Patient 4 is a 16-year-old man who presented with severe Enophthalmos 5 years after a VPS for aneurysm-related hemorrhage. Imaging demonstrated orbital enlargement and findings of intracranial hypotension. Intracranial pressure ranged between -200 and 0 mm H 2O. Shunt revision improved the Enophthalmos. Total orbital volumes were significantly greater in the study patients than in the controls. Control subjects (5 male, 5 female, ages 2345 years) had an average right orbital volume of 24.6±3.3 cm 3 (n = 10). In comparison, the right orbital volumes of patients 1 and 3 were 32.6 and 32.1 cm 3. Similar results were found for the left orbits (23.9±2.7 cm 3 [control average] vs. 35.9 and 32.6 cm 3). In patient 1, the post-shunt volumes increased 14% (right) and 23% (left) from pre-shunt volumes. In contrast, orbital fat volume was not statistically significantly different between the control group and enophthalmic patients (right orbit control mean 7.94±3.1 cm 3 [n = 10] vs. 7.9 and 9.8 cm 3; left orbit control mean 7.88+3.1 cm 3 vs. 9.2 and 10.0 cm 3). Conclusions: Enophthalmos after VPS results primarily from chronic intracranial hypotension. Low ICP causes expansion of orbital volume with no fat atrophy. In such patients, shunt revision with a pressure-regulating valve to correct intracranial hypotension should be considered. Financial Disclosure(s): The author(s) have no proprietary or commercial interest in any materials discussed in this article. © 2011 American Academy of Ophthalmology.