Manson P N, Clifford C M, Su C T, Iliff N T, Morgan R
Plast Reconstr Surg. 1986 Feb;77(2):193-202.
The mechanisms of posttraumatic enophthalmos were evaluated to determine the interrelation between fat and ligaments in globe support. Anatomic studies demonstrate that the ligaments form an essential "sling" framework for the globe but are alone insufficient to maintain the globe's full forward position. Removal of extramuscular fat in cadavers and in patients undergoing blepharoplasty did not significantly change globe position. Loss of intramuscular cone fat (atrophy or displacement) in cadavers and patients produced enophthalmos. Fat atrophy is not a prominent feature in most patients with posttraumatic enophthalmos. Some loss of intramuscular cone fat from displacement outside the muscle cone is frequently present. The principal mechanism, however, of posttraumatic enophthalmos involves a displacement and change in the shape of orbital soft tissue. Loss of bone and ligament support permits posterior displacement and a reshaping of orbital soft tissue under the influence of gravity and the remodeling forces of fibrous scar contracture. The shape of the retrobulbar orbital contents changes from a modified cone to a sphere, and the globe sinks backward and downward. Given that the volume of orbital soft tissue is constant following trauma, procedures to restore the shape and position of the orbital soft tissue by mobilization and bone reconstruction will correct or significantly improve enophthalmos.
对创伤后眼球内陷的机制进行了评估，以确定脂肪与眼球支撑韧带之间的相互关系。解剖学研究表明，韧带构成了眼球至关重要的“吊带”框架，但仅凭韧带不足以维持眼球的完全向前位置。在尸体和接受眼睑成形术的患者中去除肌外脂肪，并未显著改变眼球位置。尸体和患者中肌锥内脂肪的丧失（萎缩或移位）会导致眼球内陷。脂肪萎缩并非大多数创伤后眼球内陷患者的突出特征。肌锥外移位导致的肌锥内脂肪常有一定程度的丧失。然而，创伤后眼球内陷的主要机制涉及眼眶软组织的移位和形状改变。骨和韧带支撑的丧失使得眼眶软组织在重力和纤维瘢痕挛缩的重塑力作用下向后移位并重塑形状。眼球后眶内容物的形状从改良的锥形变为球形，眼球向后下方下沉。鉴于创伤后眼眶软组织的体积是恒定的，通过动员和骨重建来恢复眼眶软组织形状和位置的手术将矫正或显著改善眼球内陷。
