Anophthalmic Socket Surgical Risks

Side Effects / Complications of Enucleation or Evisceration surgery

• When an eye is removed, the patient loses all vision and the cosmetic use of the globe. Noted complications include hemorrhage, infection and extrusion of the implant.
• Most patients with post-operative hemorrhage are either on blood thinners (e.g coumadin, plavix, heparin or aspirin) or are known to have a bleeding disorder. Such hemorrhages can be painful, but intervention is rarely helpful. Patients are typically treated with analgesic medications (pain-killers).
• Orbital Infections are very rare, but are more common with integrated orbital implants. Most secondary orbital infections can be managed with antibiotics, covering or surgical removal of the orbital implant.

• Implant extrusions can be managed by surgical replacement of the orbital implant

  Normal Volumes of the Orbit

  • Adult orbital volume ranges from 24 to 30 ml
  • Female orbital volume is approximately 2 mm less than male adults
  • Each orbit contains approximately 10 ml of fat; extraocular muscles account for 5 ml of volume and the normal eyeball accounts for approximately 7 ml.

  Following enucleation there is a decrease in volume as well as changes in structure which give rise to what has been termed “post-enucleation socket syndrome.”

  • This involves enophthalmos, a deep upper eyelid sulcus, lower eyelid laxity with shallow fornix with possibly Ptosis or lid retraction.
  • When an eye is removed, recall there is a 7 ml volume loss; however, the most commonly used 18 ml sphere replaces a volume of approximately 3 mm while a 16 mm sphere replaces a volume of 2 ml. A 20 mm sphere provides 4.1 ml of volume.
  • The situation is made worse by orbital fat atrophy of up to 3 ml.
  • It is unclear whether fat atrophy recurs as a result of reduction of blood supply or due to mechanical manipulation during surgical enucleation.
  • Bony orbital volumes are also noted to be smaller in patients who have had long-standing enophthalmia.

Potential Complications

Exposed Orbital Implant

The Photograph on the left is an exposed orbital implant. The implant, once exposed, is at risk for extrusion. If the exposure is limited it may possibly be repaired surgically. Otherwise, it my need to be removed, and a dermal fat graft procedure performed

• Post-enucleation anophthalmic socket

is the result of the following:

 

Deep Sulcus

 

• Loss of volume
• Structural changes
• Fat atrophy
• Retraction or changes in extraocular muscles
• Loss of support of the levator complex

Poorly Fitting: