B. Traumatic telecanthus can be missed on the initial examination secondary to facial swelling. Physical clues to its presence include blunting of the palpebral fissure and absence of the caruncle. The eyelashes and lid margin can be retracted laterally, decrease of bow stringing of the medial canthal tendon and lid margin indicates medial canthal tendon damage. The intercanthal distance is usually half the interpupillary distance. The average intercanthal distance is 30-35 mm.
Repair consists of either open or closed reduction of the medial canthal tendon and lacrimal bone.
C. Enophthalmos results from orbital fat herniation, orbital wall expansion, or atrophy and contraction of orbital contents. It is frequently associated with hypophthalmos and motility problems. Diplopia is a variable finding. The findings of diplopia and muscle entrapment with forced duction testing assist in identifying patients with possible injuries to the inferior and medial orbital walls. Early exploration and repair is preferable.