To the Editor.—We read with interest, and some concern, the article by Parsons and Mathog1 in the July 1988 issue of the Archives. The authors measured changes in the volume of water contained by orbits in which fractures had been produced. They presumed that any change in orbital volume would be fully and completely translated into a change in soft-tissue distribution in the orbit, and concluded that fractures with 3-mm or more displacement of either the medial wall or floor should be operated on in order to prevent late enophthalmos.
We feel Parsons and Mathog's study is significantly flawed by the assumption that solid orbital contents, which are enveloped by periorbita and supported by various check ligaments and a complex fascial arrangement, will nonetheless act in a fluid fashion in redistributing after fracture. That this does not occur is clearly demonstrated by the response of orbital contents following
KERSTEN RC, KULWIN DR. Selective Approach to Surgery for Delayed Enophthalmos. Arch Otolaryngol Head Neck Surg. 1989;115(5):634. doi:10.1001/archotol.1989.01860290092025
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