Enophthalmos in Dogs

Enophthalmos in dogs can be caused by abnormalities within the sympathetic nerves in the eyes and also within the muscles of the face. Enophthalmos is when the eyeball is further back in position than normal within the eye orbit. This can occur due to possible bone changes within the orbit in comparison to the orbital fat and eyeball. It may also occur due to possible function loss of the muscle around the orbit, or orbitalis muscle. If a dog has Horner's syndrome, they will have enophthalmos, a small pupil, a droopy eyelid and protrusion of the “third eyelid” as well.

 The orbit is the socket within the skull that contains the eye and surrounding appendages. In enophthalmos, the eye is sunken back into the skull.

Enophthalmos in dogs is a condition in which the eye, within the cavity, is dispositioned. Typically, enophthalmos presents itself with the eyeball of the dog being positioned further back within the socket than normal.

Enophthalmos that occurs alongside Horner's syndrome, is a neurological disorder which is quite common among dogs. The symptoms may suddenly occur, and include:

• Droopy eyelid
• Constricted pupil
• A “sunken” eye
• A noticeable third eyelid that is raised and bright red

Types

One of the causes of enophthalmos can be due to specific types of parasites or fungi that may enter into the orbital region of the eye. They may enter through the nasal cavity and sinuses. Such parasites include:

• Cryptococcus neoformans
• Blastomyces dermatitidis
• Aspergillus 
• Coccidioides immitis
• Candida

Enophthalmos linked with Horner's Syndrome in dogs can be caused by a variety of specific disorders.  Causes of this condition are determined by a veterinarian through physical examinations, lab work, and thorough assessment of the orbital cavity of the affected eye of the dog. Causes s in dogs include:

• Cysts
• Myositis
• Vascular abnormalities
• Parasites and fungi
• Foreign bodies
• Trauma
• Bite wound
• Disc conditions of the back
• Middle ear infection
• Tumor
• Idiopathic (no known cause)

If your dog is showing symptoms of enophthalmos, make an appointment with your veterinarian. Once you have arrived at the veterinarian’s office, your veterinarian will begin by performing a complete physical examination of your dog. He will check your dog’s vital signs, perform bloodwork, and a urinalysis. These tests will check for any underlying conditions that may be causing his enophthalmos. Your veterinarian will also examine your dog’s affected eye and will order a sonogram, or ultrasonogram, to be performed. This will allow the veterinarian to take a closer look at what could be causing the abnormal orbital space. An ultrasonogram will make it clear to the veterinarian if your dog has a fluid substance within the area or a solid mass. He may also perform an aspiration to sample either the fluid or the mass, if either is present. The medical professional may also perform an MRI to further examine the soft tissue. 

The veterinarian may also perform any other neurological and ophthalmologic tests to further investigate the orbital abnormality. If the veterinarian suspects disc disease that is affecting the nerves, he will perform tests to decipher the extent of the nerve damage within the upper back. 

One common ophthalmologic test which may be performed is testing the response of the pupils. The medical professional will topically apply adrenergics, typically epinephrine, to both of your dog’s eyes to check the dilation response of the pupils. Within the normal pupil, the veterinarian will expect no abnormal response; however, in the affected pupil, there may be a dilation in which the veterinarian will be able to conclude as to the type of lesion affecting your dog’s eye and causing the syndrome.

Enophthalmos in dogs is caused by a variety of underlying conditions. Treatment will vary depending on precisely what has caused enophthalmos in your dog. Treatment methods may include:

Antibiotic Therapy

If your dog’s condition was caused by an infection that developed within the orbital eye cavity, the veterinarian will prescribe specific antibiotics to get rid of the infection. The antibiotics may be topical, oral, or both, depending on the specific infection your dog has been diagnosed with.

Draining

If your dog has an abscess or cyst that has caused his enophthalmos, the veterinarian may perform a procedure to drain it. This procedure may be performed within one day, or your dog may have to stay overnight in order to be sure the drainage is successful and that he begins to heal properly. This will be followed by giving him specific medications, such as antibiotics, for him to take after the minor surgical procedure.

Antifungal Medications

If your dog has a fungal infection which has caused his orbital abnormality, the veterinarian will prescribe antifungal medications to treat the specific fungus that has invaded the orbital cavity. Your dog will need to take these medications either orally or topically, or both.

Removal of Foreign Object

If your dog has a foreign object in the eye, your veterinarian may have to do a small surgical procedure to remove it. Foreign objects within the eye may be able to be removed without any surgical intervention, as well. If your dog needs a surgical procedure, this may include an overnight stay and be followed up with antibiotics to prevent any infection from occurring.

If your dog has Horner's, this typically resolves spontaneously with no intervention.

An Elizabethan collar (cone) may need to be worn by your dog if they are rubbing at the eye, and it is highly recommended that it stays on him the whole time he is recovering. This will prevent your dog from pawing at his eye and further irritating it, thus preventing the treatment from being effective.

Typically, enophthalmos can be successfully treated (or will resolve by itself) and the eye will successfully heal in time. Your dog may be put on prescription medications that you may need to give him at home. Your veterinarian will give you specific instructions on how to administer any medications to your dog. The medications may be in the form of eye drops, eye gel, or in pill form. Be sure your dog takes the medication as prescribed.

In terms of enophthalmos caused by intervertebral disc disease, your veterinarian will recommend surgery, medication and/or physical therapy to treat the nerve damage. He may also give you medications for this as well, or possibly at-home treatments that you can do with your dog.

The recovery and management of your dog’s enophthalmos solely depends on the cause of the syndrome to begin with. Rest assured, this condition is usually treatable, and with your help and with following the veterinarian’s instruction for aftercare, your dog should recover in time. Your veterinarian will want to see your dog for future visits to be sure he is recovering in a timely manner and making progress with his underlying condition. If you see any new symptoms develop, do not hesitate to contact your veterinarian in between follow-up visits.