title: Orbital Volume Augmentation for Enophthalmos Following Ventriculoperitoneal Shunting: A Case Study in "Silent Brain Syndrome".
abstract: A 21-year-old female with a history of infantile hydrocephalus and ventriculoperitoneal shunting presented with bilateral persistent tearing. Examination revealed marked bilateral enophthalmos, poor lower eyelid apposition to the ocular surface, and patent nasolacrimal systems. Radiographic imaging demonstrated expanded orbital volumes with high arching orbital roofs, sequestered air under the eyelids, short, straight optic nerves, and expanded paranasal sinuses. Surgical intervention included insertion of mesh and block implants within the subperiosteal space of the orbital roof, resulting in correction of enophthalmos, improved lower eyelid apposition and resolution of tearing. However, new onset myopic astigmatism and bilateral ptosis were noted postoperatively and treated successfully with corrective spectacles and ptosis repair. Current literature has demonstrated the benefit of orbital roof implants through a upper eyelid crease incision. The authors present a case that supports the utility of this approach and addresses its potential complications, including postoperative-induced astigmatism/myopia and ptosis.
authors: *Center for Facial Appearances, Salt Lake City, Utah; †Cincinnati Eye Institute, Cincinnati, Ohio; and ‡Department of Ophthalmology, University of Cincinnati College of Medicine, Cincinnati, Ohio, U.S.A.
authors: Jonathan M
authors: JM
authors: Pargament
authors: Robert J
authors: RJ
authors: Peralta
authors: Jeffrey A
authors: JA
authors: Nerad
authors: John D
authors: JD
authors: McCann
mesh_terms: D015841:Enophthalmos / Q000175:diagnosis / Q000209:etiology / Q000601:surgery*; D005260:Female; D006801:Humans; D006849:Hydrocephalus / Q000601:surgery*; D013508:Ophthalmologic Surgical Procedures / Q000379:methods*; D009915:Orbit / Q000000981:diagnostic imaging / Q000601:surgery*; D014057:Tomography, X-Ray Computed; D017287:Ventriculoperitoneal Shunt / Q000009:adverse effects*; D055815:Young Adult