My eyes have lost volume themselves,not the eye fat.Theories?

[charlesb2117]

Had a  head injury in 2003 which caused a left temporal lobe fracture which fractured my  cribriform plate and radiated down my my left eye orbit. I had metal plates put in along with a craniotomy with no eye symptoms since then. However, in 2006 I was hit with a blunt object around my eyes. In 2010, my eyes have lost volume themselves (not the eye fat) up until 2019. Steroid eyedrops and antibiotics have not stopped the loss of volume. How can I go about asertaining the cause of this volume loss?The eyes have progressively become smaller with a more cuboidal appearance. No redness, but I do have blepharitis along with meibomian gland dysfunction with acidic, white discharge upon waking up in the morning which causes a burning sensation. Eyelids are slightly swollen with a non-burning "soapy/bubbly" discharge on the eyelids and moderately dry eyes, and the gap of the fracture above the left eye seems to have opened more wide over time. I dont know if the open fracture could have cause cross-contamination. Would a B-scan ultrasonagraphy be a good start to ascertain what's going on in the eyes? CT scans just show mucousal thickening in ethmoid sinuses and a CSF leak is a possibility, Onodi cells were noted, along with fractures stated above. Not looking for an exact diagnosis just theories, considering the limitations over the internet. Thank you.

[JohnHaganMD]

It is very unlikely that as an adult your eye is getting smaller. The adult sclera (white wall) is rigid  and does not get smaller. The main exception is if severe injury or disease and the eye stops producing aqueous fluid (hypotony) which can cause an eye to die and shrink like a prune (pthisis bulbi).  More likely either their is loss or gain of oribal volume or the eyelids are drooping down (ptosis) which makes the eye look smaller. In hyperthyroid its just the opposite the lids are elevated and makes the eyes look bigger. You need an A scan not B scan the form will measure the length of the eye and confirm normal. you do need to see a properly trained ophthalmologist.

[charlesb2117]

Can the A scan determine normal size despite no previous A scans were performed? What kind of ophthalmologist should I see to perform the A scan or can it be either specialty? Thanks in advance.

[JohnHaganMD]

No previous A scan needed.  You would need to ask when you called to make an appointment. Most Eye MDs have A scan since needed for determining IOL power.    General ophthalmologist or oculoplastic surgeon.