{"schema":"https://ver.cy/schemas/card/1.0.0","id":"vr.tr.enophthalmos","code":"thing-q1343593","url":"https://ver.cy/models/thing/q1343593/","name":"enophthalmos","alternateNames":["Silent sinus syndrome"],"kind":"thing","status":"published","version":"0.1.0-research.1","language":"en","classifiers":{"family":"Thing Registry","category":"Cross-cutting context","entryKind":"thing","plane":"XCT","domain":["XCT.STA"],"industry":[],"navPath":"","tags":[],"facets":{}},"whatItIs":"Enophthalmos is posterior displacement of the eyeball within the bony orbit relative to its normal position, resulting from an altered relationship between orbital capacity, orbital contents and their supporting tissues.","purpose":"Enable an agent to recognize enophthalmos, characterize posterior globe displacement, assess its consequences, and support appropriate clinical evaluation and follow-up.","scope":{"in":["True posterior globe displacement within the orbit, including laterality and temporal course","Distinction between measured displacement and an apparently sunken eye","Reproducible globe-position measurements and their reference frames","Evidence linking displacement to orbital structural changes","Associated functional impairment, appearance concerns, and clinical disposition"],"out":["Complete models of orbital fractures, sinus disease, tumors, or other underlying causes","Proptosis as an independently modeled anterior displacement state","Primary abnormalities of globe size or eyelid position","Detailed operative techniques, implant specifications, and surgical prescribing","General ophthalmic disease assessment unrelated to globe displacement"],"boundaries":[]},"distinguishingFeatures":["Confirm posterior globe displacement relative to an explicit orbital reference, rather than relying only on a sunken appearance. [Clinical definition](https://pubmed.ncbi.nlm.nih.gov/18462475/)","Record globe size and integrity to distinguish displacement from apparent recession caused by a small or shrunken globe. [Differential assessment](https://www.ncbi.nlm.nih.gov/books/NBK563300/)","Separate posterior displacement from hypoglobus, which describes inferior globe displacement; both may coexist. [Positional distinctions](https://www.ncbi.nlm.nih.gov/books/NBK563300/)","Establish whether the comparison eye is itself proptotic before interpreting asymmetry as enophthalmos. [Differential diagnosis](https://www.ophed.com/system/files/2009/07/enophthalmos-article-1795-1795.pdf)","Do not equate isolated ptosis or a deep superior eyelid sulcus with confirmed posterior globe displacement. [Clinical assessment](https://pmc.ncbi.nlm.nih.gov/articles/PMC11562999/)"],"structure":{"bundles":[{"id":"recognition-and-boundaries","name":"Recognition and boundaries","description":"Establish whether the registered positional state is present.","layers":[{"id":"posterior-position","name":"Posterior position","description":"Locate the globe relative to a defensible orbital reference.","findings":[{"id":"evidence-of-recession","name":"Evidence of recession","description":"Record the observation supporting true posterior displacement and the confidence assigned to it.","questions":[{"text":"What examination or imaging evidence establishes posterior displacement within the orbit?","id":"evidence-of-recession-q01","kind":"definition"},{"text":"Which anatomical reference and comparison establish that the position is abnormal?","id":"evidence-of-recession-q02","kind":"measurement"}]}]},{"id":"apparent-recession","name":"Apparent recession","description":"Separate the positional state from neighboring explanations of appearance.","findings":[{"id":"mimics-and-coexisting-malposition","name":"Mimics and coexisting malposition","description":"Document globe-size abnormalities, eyelid changes, comparison-eye abnormalities, and non-posterior displacement separately.","questions":[{"text":"Could reduced globe size, eyelid position, or contralateral proptosis explain the apparent recession?","id":"mimics-and-coexisting-malposition-q01","kind":"boundary"},{"text":"Is any inferior or horizontal globe displacement present in addition to posterior recession?","id":"mimics-and-coexisting-malposition-q02","kind":"measurement"}]}]}]},{"id":"measurement-and-comparability","name":"Measurement and comparability","description":"Make globe-position measurements interpretable across examinations.","layers":[{"id":"measurement-reference","name":"Measurement reference","description":"Record how each position estimate was obtained.","findings":[{"id":"instrument-and-landmark-validity","name":"Instrument and landmark validity","description":"Hertel measurements depend on lateral orbital rim integrity; record compromised landmarks. [Measurement limitations](https://www.ncbi.nlm.nih.gov/books/NBK563300/)","questions":[{"text":"What were the readings for both eyes, instrument type, base setting where applicable, and observer?","id":"instrument-and-landmark-validity-q01","kind":"measurement"},{"text":"Have trauma, surgery, or anatomical asymmetry altered the landmarks used by this method?","id":"instrument-and-landmark-validity-q02","kind":"boundary"}]}]},{"id":"interpreting-differences","name":"Interpreting differences","description":"Distinguish supported recession from reference error and measurement variation.","findings":[{"id":"comparator-and-threshold","name":"Comparator and threshold","description":"Require an explicit comparator and justification for any diagnostic or change threshold, especially in bilateral cases.","questions":[{"text":"Is interpretation based on the fellow eye, an earlier measurement, or a justified reference population?","id":"comparator-and-threshold-q01","kind":"provenance"},{"text":"What supports the chosen threshold, and does the observed difference exceed uncertainty for this measurement method?","id":"comparator-and-threshold-q02","kind":"measurement"}]}]}]},{"id":"orbital-mechanism-and-cause","name":"Orbital mechanism and cause","description":"Connect posterior displacement to supported anatomical mechanisms and causal conditions.","layers":[{"id":"structural-mechanism","name":"Structural mechanism","description":"Describe the anatomical explanation without forcing a single cause.","findings":[{"id":"space-content-and-retraction","name":"Space, content, and retraction","description":"Assess orbital cavity enlargement, soft-tissue volume loss, and fibrotic retraction as possible mechanisms. [Mechanism overview](https://www.ncbi.nlm.nih.gov/books/NBK563300/)","questions":[{"text":"What evidence supports increased orbital space, reduced orbital contents, a retractile process, or a combination?","id":"space-content-and-retraction-q01","kind":"provenance"},{"text":"Which orbital walls, fat compartments, or other tissues are implicated by the available examination or imaging?","id":"space-content-and-retraction-q02","kind":"measurement"}]}]},{"id":"causal-attribution","name":"Causal attribution","description":"Link mechanisms to events or diseases at an appropriate confidence level.","findings":[{"id":"supported-causal-link","name":"Supported causal link","description":"Record evidence for a related injury, procedure, sinus disorder, or other condition without treating temporal association as proof.","questions":[{"text":"Which preceding event or diagnosed condition is proposed to explain this eye's recession, and what supports that link?","id":"supported-causal-link-q01","kind":"provenance"},{"text":"Which alternative causes remain unresolved, and what additional clinician-directed evaluation could distinguish them?","id":"supported-causal-link-q02","kind":"action"}]}]}]},{"id":"course-and-clinical-burden","name":"Course and clinical burden","description":"Represent change over time and its functional and personal consequences.","layers":[{"id":"onset-and-evolution","name":"Onset and evolution","description":"Reconstruct when recession appeared and how it has changed.","findings":[{"id":"documented-position-trajectory","name":"Documented position trajectory","description":"Keep reported onset, first documentation, and comparable serial measurements distinct.","questions":[{"text":"When was recession first noticed, and what earlier photographs or examinations document baseline appearance or position?","id":"documented-position-trajectory-q01","kind":"provenance"},{"text":"Do comparable observations support stability, progression, or improvement, and what limits that conclusion?","id":"documented-position-trajectory-q02","kind":"measurement"}]}]},{"id":"functional-and-appearance-effects","name":"Functional and appearance effects","description":"Record consequences without automatically attributing every ocular symptom to recession.","findings":[{"id":"attributable-burden","name":"Attributable burden","description":"Separate observed impairment, reported distress, and the evidence connecting each to globe position.","questions":[{"text":"Are diplopia, motility restriction, eyelid-closure difficulty, or visual changes documented, and what is their proposed relationship to the orbital abnormality?","id":"attributable-burden-q01","kind":"boundary"},{"text":"Which appearance changes or activity limitations matter to the person, and how are those concerns recorded over time?","id":"attributable-burden-q02","kind":"measurement"}]}]}]},{"id":"clinical-disposition-and-outcomes","name":"Clinical disposition and outcomes","description":"Support clinician-led next steps and evaluation of their results.","layers":[{"id":"assessment-disposition","name":"Assessment disposition","description":"Make the rationale for further assessment or monitoring explicit.","findings":[{"id":"next-step-rationale","name":"Next-step rationale","description":"Record the responsible clinician's disposition and unresolved orbital or visual findings influencing it.","questions":[{"text":"Are acute visual changes, trauma-related findings, or progressive unexplained recession present for clinician assessment of urgency?","id":"next-step-rationale-q01","kind":"action"},{"text":"What supports observation, additional investigation, or specialist referral, and who owns the next step?","id":"next-step-rationale-q02","kind":"action"}]}]},{"id":"response-and-residual-state","name":"Response and residual state","description":"Assess outcomes against the original positional and functional objectives.","findings":[{"id":"multidimensional-outcome","name":"Multidimensional outcome","description":"Track globe position, associated impairment, personal concerns, and adverse effects separately after management.","questions":[{"text":"What changed in measured recession and associated symptoms using comparable pre-management and follow-up observations?","id":"multidimensional-outcome-q01","kind":"measurement"},{"text":"What residual displacement, new symptoms, or unmet personal priorities require reassessment?","id":"multidimensional-outcome-q02","kind":"action"}]}]}]},{"id":"evidence-and-external-alignment","name":"Evidence and external alignment","description":"What the world already says about this thing, gathered so the model can be checked against it.","layers":[{"id":"reported-evidence","name":"Reported evidence","description":"Findings from the breadth pass, kept separate from the structural claims.","findings":[{"id":"evidence-confidence-notes","name":"Check these first","description":"Recalled without web access and unsourced; every item is a lead to verify.","questions":[{"text":"Which of these check these first hold for the sense of enophthalmos this model covers, and on what evidence?","id":"evidence-confidence-notes-q01","kind":"provenance"}]},{"id":"evidence-kinds","name":"Kinds and varieties","description":"Recalled without web access and unsourced; every item is a lead to verify.","questions":[{"text":"Which of these kinds and varieties hold for the sense of enophthalmos this model covers, and on what evidence?","id":"evidence-kinds-q01","kind":"provenance"}]},{"id":"evidence-identifiers","name":"Identifiers and schemes","description":"Recalled without web access and unsourced; every item is a lead to verify.","questions":[{"text":"Which of these identifiers and schemes hold for the sense of enophthalmos this model covers, and on what evidence?","id":"evidence-identifiers-q01","kind":"provenance"}]},{"id":"evidence-real-world-use","name":"Real-world use","description":"Recalled without web access and unsourced; every item is a lead to verify.","questions":[{"text":"Which of these real-world use hold for the sense of enophthalmos this model covers, and on what evidence?","id":"evidence-real-world-use-q01","kind":"provenance"}]},{"id":"evidence-measurements","name":"Typical measurements","description":"Recalled without web access and unsourced; every item is a lead to verify.","questions":[{"text":"Which of these typical measurements hold for the sense of enophthalmos this model covers, and on what evidence?","id":"evidence-measurements-q01","kind":"provenance"}]},{"id":"evidence-failure-modes-and-hazards","name":"Failure modes and hazards","description":"Recalled without web access and unsourced; every item is a lead to verify.","questions":[{"text":"Which of these failure modes and hazards hold for the sense of enophthalmos this model covers, and on what evidence?","id":"evidence-failure-modes-and-hazards-q01","kind":"provenance"}]},{"id":"evidence-neighbours","name":"Neighbouring kinds and how to tell them apart","description":"Recalled without web access and unsourced; every item is a lead to verify.","questions":[{"text":"Which of these neighbouring kinds and how to tell them apart hold for the sense of enophthalmos this model covers, and on what evidence?","id":"evidence-neighbours-q01","kind":"provenance"}]}]}]}]},"agentConduct":{"may":["Explain enophthalmos and its causes from medical sources.","Advise urgent care after facial injury with eye changes."],"mustNot":["Diagnose the cause or advise delaying care.","Infer a disease from photos of a person's face without consent.","Mock changes in a person's appearance."],"requiresHuman":["Any treatment or surgery on the orbit."]},"ethics":{"considerations":["Changes to the face affect dignity and self-image.","It can signal fractures or tumours that need prompt care."],"affectedParties":["Patients","Trauma victims","People photographed"]},"owners":{"steward":"The person whose body it is; clinicians treat it with consent.","roles":[],"masterSystems":[]},"relations":[{"target":"Q18558098","type":"parent","note":"registry parent class"}],"interaction":{"identity":{"applicability":"required","items":["Vercy registry: vr.tr.enophthalmos","Wikidata: Q1343593 (https://www.wikidata.org/wiki/Q1343593)"]},"properties":{"applicability":"not-applicable","items":["Confirmation status: suspected | confirmed | apparent recession without confirmed displacement | indeterminate","Laterality: right | left | bilateral","Globe projection: mm for each eye, with instrument, anatomical reference, base setting where applicable, and examination date","Relative posterior displacement: mm relative to a named comparator, with an explicit sign convention","Reference validity: usable | compromised | uncertain, with reason","Temporal course: newly observed | longstanding | progressive | stable | improving | unknown; onset and observation dates","Additional displacement: vertical and horizontal displacement in mm where measured, with direction and reference","Mechanism attribution: linked orbital enlargement, tissue-volume loss, retractile process, mixed mechanism, or unresolved cause; supporting evidence and confidence","Functional and personal burden: documented diplopia, motility limitation, eyelid-closure difficulty, visual change, and patient-reported appearance concern"]},"recognition":{"applicability":"optional","items":["One eye looks sunken compared with the other.","A deeper upper eyelid fold on the affected side."]},"capabilities":{"applicability":"required","items":["Classify a sunken-eye observation as suspected, confirmed, apparent, or unresolved enophthalmos.","Compare serial globe-position observations when their measurement references are compatible.","Identify missing evidence needed to distinguish positional change from globe-size or eyelid abnormalities.","Link supported causal mechanisms to neighboring disease or injury models.","Summarize symptoms and examination findings for clinician-led assessment of urgency and management.","Track positional, functional, and patient-reported outcomes after observation or treatment."]},"hazards":{"applicability":"required","items":["Double vision from orbital fractures.","Missed underlying tumours."]},"interfaces":{"applicability":"required","items":["The International Classification of Diseases, Tenth Revision, issued by the World Health Organization, classifies enophthalmos under H05.4."]},"context":{"applicability":"required","items":["Enophthalmos is encountered in ophthalmology, orbital surgery and assessments of facial injury or orbital disease.","The term describes a clinical finding used to document globe position and investigate changes in orbital volume, contents or supporting tissues."]}},"sources":[{"title":"Wikidata item Q1343593: enophthalmos","url":"https://www.wikidata.org/wiki/Q1343593","note":"identity and sense of the item"},{"title":"Wikipedia: Enophthalmos","url":"https://en.wikipedia.org/wiki/Enophthalmos","note":"general description of the item"}],"openQuestions":["Which method-specific and population-appropriate reference ranges best support recognition when both eyes are affected or no reliable baseline exists?","What minimum detectable change should be used for each clinical or imaging measurement method when orbital landmarks are altered?","How should the model distinguish persistent enophthalmos from gaze-dependent globe retraction without conflating their mechanisms?","Which evidence best separates the contributions of orbital enlargement, tissue loss, and fibrosis in mixed-mechanism cases?","Which validated outcome measures and follow-up intervals best capture functional benefit and patient-valued appearance changes across different causes?"],"resources":{"spec":"/models/things/publications/thing-q1343593/spec.json"},"provenance":{"origin":"thing registry research (pass 2)","builtFrom":["models/things/publications/thing-q1343593/spec.json"],"providers":["Codex"],"researchStatus":"unreviewed","generatedAt":"2026-09-12T09:29:47Z","builder":"tools/build_cards.py@1.0.0"},"completeness":{"sections":{"classifiers":"filled","whatItIs":"filled","purpose":"filled","distinguishingFeatures":"filled","structure":"filled","agentConduct":"filled","ethics":"filled","owners":"filled","relations":"filled","interaction.identity":"filled","interaction.properties":"not-applicable","interaction.recognition":"filled","interaction.capabilities":"filled","interaction.hazards":"filled","interaction.interfaces":"filled","interaction.context":"filled","sources":"filled"},"notes":{"_gate":"Published through the thing publication gate 1.0 on 2026-10-07T10:10:26+00:00: completeness 1.00; sense: Wikidata description; 2 live sources; review by codex: pass","interaction.properties":"Plane XCT: no invented physical properties."},"score":1.0}}