scleromalacia worsening from orbital fracture?

Hello,

I'm  a 31 y/o male. In 2003 I had a head injury that caused a frontal lobe fracture. In 2006 I was hit in my left eye orbit with a blunt object with no hospitalization/CT scan. Since Febuary 2010 I got swollen eyelids out of nowhere, accompanied by dryness and some sharp pain in both eyes for no reason (trauma) and the eye doctors had no explanation. In October of 2010 I went to an ocular plastic surgeon because my left eye looked sunken and indented on the side near the nose;doesnt have a normal round shape anymore. My left eye is seems to be sinking more over time and more indented too. Consequently, the plastic surgeon had me do an orbit CT scan. The neuroradiologist in October 2010 stated:

""There is encephalomalacia in the left anterior and inferior lefter greater than right frontal lobes compatible with old contusions. There is film cut off paranasal bone. There is mucosal thickening of multiple ethmoidal air cells with opacification of the left middle ethmoidal air cell. There is a defect in the left frontal bone. There is minimally depressed fracture fragment measuring 4mm in length adjacent to the frontal sinus. there is a left frontal craniotomy defect. the fracture involves the left frontal bone. there is small plat and screws fixating the bifrontal craniotomy defect. there is deformity of the left cribriform plate. there is opacification of the left ethmoidal air cells which in conjunction with the defect of the left cribriform plate is worrisome for CSF leak. there is a fracture through the superior to the superior and through the meatal aspect of the superior wall of the left orbit. there is also deformity of the right cribriform plate with a questionable defect through the anterior and inferior cribriform plate. The lacrimal glands are symmetric in size. there is no enlargement of the extraocular muscles or crowding in the orbital apices,
Impression:
1.comminuted fracture of the left frontal bone involving the superior wall of the left orbit with a defect through the left cribriform plate.
2.Encephalomalacia in the left greater than right inferior right frontal lobes compatible with old contusions.
3. A deformity with a questionable defect through the right cribriform plate
4. The findings are worrisome for a CSF leak given the opacification of several left ethmoidal air cells and a defect through the left cribriform plate.
5. Bifrontal craniotomy defect.
6. No retrobulbar induration, gross retrobulbar mass
7. Continued followup including a neurosurgical consultation may be helpful given the defect of the cribriform plate."

I have seen a neurosurgeon who says I dont have a CFS leak. I saw another plastic surgeon who said he cant do anything to bring the eye out. I currently saw a general ophthalmologist who says I have scleral thinning called scleromalacia when I complained about the indentation on the inner side of my left eye. My eye gets worse (more concave) overtime whenever I get pain. The general ophthalmologist said we should just take a watch and wait approaach and denied referring me to a cornea specialist even though my eyes look deformed.

I have no history of any disease except very low testosterone, chronic pain in my lower left abdomen, and impacted wisdom teeth. The head fracture caused in 2003 never showed any acute eye effects that I have now (i.e. orbital fracture, enopthalmos, dryness, discharge and pain); I personally believe the orbital fracture is opening somehow overtime possibly caused by low testosterone weakening the bones or minor, unnoticed trauma (2006 left orbital impact). Could the scleral thinning be caused by an infection in the sinuses, teeth or anywhere near the eyes? Or is it possible that my eyes are being squeezed somehow? I know its alot but I just keep hitting "road blocks" and will appreciate your professional advice. Thank you.

[John C Hagan III, MD, FACS, FAAO]

It is very unlikely that scleral thinning is due to infection near the eyes. If you are in a  plan where referral to a corneal specialist requires your GP's okay then explain the situation and by-pass your present ophthalmologist, if you can refer yourself then get going. This is such a unique set of problems that one cannot generalize.
JCH DM