Surgical management of volumetric changes in the bony orbit.

This article demonstrates that the periorbital fat, instead of being continuous and freely flowing, is encased within 3 compartments: 1 anterior to the extraocular muscles, 1 external to the extraocular muscles, and 1 deep to the extraocular muscles. In addition, the study establishes that fat loss anterior to the axis of the globe does not affect the anteroposterior location of the eye itself. Only fractures located posterior to the axis produce enophthalmos, and only operative procedures that create bony enlargement and fatty displacement behind this axis correct exophthalmos. Furthermore, only adding volume behind the axis of the globe can correct enophthamos. Finally, if there is sufficient space between the top of the globe and the bony roof, volume additions at the axis of the globe can correct vertical dystopia without producing exophthalmos.