Cataract surgery and the deep-set eye

Cataract phacoemulsification in the setting of orbital structural anomalies that lead to a deep-set eye can present unique barriers to standard surgical methods. We describe a challenging case of a middle-aged woman presenting with elevated intraocular pressure secondary to phacomorphic changes in the left eye requiring lensectomy and goniosynechialysis. She had small and deep-set eyes with inferiorly positioned superior orbital rims unsuitable for the standard approach of cataract extraction with phacoemulsification. We examine etiologies of enophthalmos that might make cataract and other intraocular surgeries difficult and discuss potential planning strategies to address these anatomic impediments.