Enophthalmos is a frequent sequalae of varied aetiologies. Reliable, reproducible and accurate measurement of globe retrusion consistently poses difficulties. Significant post-traumatic enophthalmos is an indication for surgical management, however such diagnosis should be made objectively, and thus a robust method for quantifying the degree of globe displacement is key. Current methods of measuring enophthalmos have long been considered unreliable and inconsistent, in particular with inter-observer variability. This systematic review is aimed at reviewing all the contemporary methods of measuring enopthalmos. The review analysed the reliability of these measuring tools, as well as their correlation between other methods. A proposal for an accurate and reliable measure of the protrusion of an eye is provided. This protocol aims to standardise assessment of patients, and thus create a uniform approach which can be used to select patients who are most likely to benefit from operative management.
Analysis of the data showed CT exophthalmometry to be the most reliable, followed by the Mourits exophthalmometer. The latter performed optimally compared with all clinical modalities of proptosis measurement.
In the acute phase of orbital blow-out fractures, the measurement of herniated tissue through a fracture defect may give a good prediction of the degree of enophthalmos that is likely to occur if no corrective surgery is performed. Herniated volume measurement and CT exophthalmometry should be the foundation for diagnosis and management planning. Three dimensional imaging or Mourits’ exophthalmometers were reliable non- radiological methods of, which could be used in a follow up protocol.