title: Periorbital and Orbital Aging: Senile Enophthalmos as a Cause of Upper Eyelid Ptosis.
abstract: BACKGROUND
  The aim of this study was to assess the effects of orbital aging over a prolonged period.
  
  
  METHODS
  The orbit and periorbital region were assessed in 21 adult patients over 6 to 24 years with medical-quality facial photographs. The anteroposterior and lateral photographs were evaluated for orbital changes, including enophthalmos and upper eyelid position. Quantitative analysis was performed on the anteroposterior photographs, and qualitative analysis was used to assess enophthalmos.
  
  
  RESULTS
  The mean age of the patients was 40 years at initial photography and 57 years at the time of secondary photography. At initial photography, eight of the 21 patients had ptosis: six had bilateral mild ptosis (<2 mm), one had bilateral moderate (2 to 3 mm) ptosis, and one had unilateral mild ptosis. At the second time point, only two patients did not have ptosis: four had unilateral mild, seven had bilateral mild, and eight had bilateral moderate ptosis. One patient had unilateral and two patients had bilateral enophthalmos at the initial photography. Nineteen of the 21 patients had relative enophthalmos at the second time point, and all 19 of the patients had eyelid ptosis (p < 0.00001).
  
  
  CONCLUSIONS
  This study demonstrates the development of age-related enophthalmos and eyelid ptosis and the strong association between age-related enophthalmos and upper eyelid ptosis, which is commonly undetected.
authors.affiliation: Cleveland, Ohio.|From the Department of Plastic Surgery, Case School of Medicine; and the Department of Plastic Surgery, University Hospital Case Medical Center.
authors.forename: Bahman
authors.initials: B
authors.lastname: Guyuron
authors.affiliation: Cleveland, Ohio.|From the Department of Plastic Surgery, Case School of Medicine; and the Department of Plastic Surgery, University Hospital Case Medical Center.
authors.forename: Donald
authors.initials: D
authors.lastname: Harvey
mesh_terms: D000293:Adolescent; D000328:Adult; D000375:Aging; D001763:Blepharoptosis / Q000175:diagnosis / Q000453:epidemiology / Q000209:etiology*; D002648:Child; D015841:Enophthalmos / Q000150:complications* / Q000175:diagnosis; D005143:Eyelids / Q000000981:diagnostic imaging*; D005260:Female; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D009915:Orbit / Q000000981:diagnostic imaging*; D010781:Photography; D012189:Retrospective Studies; D012720:Severity of Illness Index; D014057:Tomography, X-Ray Computed; D014481:United States / Q000453:epidemiology; D055815:Young Adult