The post-traumatic enophthalmos which arises some weeks or months later after injury, is real problem clinically, perhaps accompanied by ptosis of the eyeball. This may of course be due to failure to carry out any surgical correction of injury, but it may also be seen when surgery has indeed been carried out as a primary procedure shortly after the accident, if the primary surgery has been inadequately carried out. The clinical picture of ehophthalmos accompanied by hollowing of the upper lid may, however, be seen in patient who have had adequate primary surgery but who develope later enophthalmos for the reasons of cicatrical necrosis and scar contracture of the deep orbital tissues.
However, the vertical axis of the glove nearly coincides with the lateral orbital rim, so the position of the lateral wall gretly influences the antero-posterior position of the globe, Furthermore, access to retrobulbar plane through a lateral path is more direct then traveling along the floor, working along the lateral wall also offers a greater zone of safety, since the optic nerve enters the orbit from a medial direction.
To abtain direct approach and adequate exposure of the lateral orbital wall, we used a hemicoronal incision combined with lower lid approach, so total correction of enophthalmos was achieved in each case. Slight exophthalmos and transient diplopia can occur, but is resolved within 6 months.
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