sunken eye, discomfort

My boyfriend has one eye that now looks more sunken than the other. He had some blunt trauma to the eye from being hit by a softball several weeks ago, and an x-ray and head CT last week ruled out orbital blowout fracture and brain injury.

His vision is good (20/18), but he says that it now hurts to move his eyes. He added that his injured eye sometimes gets swollen, unusually watery, feels "pumped with air".  I see light swelling on the affect side of his face. Our Eye MD sees nothing wrong (no corneal lacerations, hyphema...).

What could be causing the uneven eyes? Will it resolve on its own, or is the eye injury something more serious (e.g. rupture, ischemia, nerve pain) that will need close attention?  

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

The injury can cause atrophy (wasting) of the fat behind the eye giving it a sunken appearance. I suggest he see a Eye MD oculoplastic surgeon. If you live in USA find one near you at www.aao.org or ask the ophthalmologist he saw to refer him.

JCH MD

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

The injury can cause atrophy (wasting) of the fat behind the eye giving it a sunken appearance. I suggest he see a Eye MD oculoplastic surgeon. If you live in USA find one near you at www.aao.org or ask the ophthalmologist he saw to refer him.

JCH MD

[eunjung]

Dr. Hagan,

I will give your advice to my boyfriend.

I spoke to him an hour ago. He has some eye surface pain now, but he can still see well.  My boyfriend also said something about his eye leaking, but the doctor said it was tearing. I am concerned that my boyfriend might have a scleral wound that wasn't caught during his examination. Might he need surgery?  If he has a hidden wound, what could his prognosis be, especially since he has had related symptoms for weeks?

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

A ruptured globe is a very dramatic event and is usually associated with pain, bad vision, infection, etc. So it's unlikely.

JCH MD

[eunjung]

He definitely has pain. From what he showed me, he did not get scans that show dramatic change in his eyeballs. He says that there is a "fullness" in his uninjured side that he does not feel in his injured eye.

I don't know if his globe is ruptured, but it looks slightly uneven when I look at him.

Would a "small" wound in the sclera heal itself over weeks or months?

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

It could although everything is speculation and supposition. He needs to see an ophthalmologist ideally an oculoplastic surgeon.

JCH MD