Abstract
Surgical correction of an anophthalmic enophthalmos secondary to inappropriate repair of the eye socket involves several difficult aesthetic issues associated with long-term use of a poorly fitting prosthetic eye. In this paper, we present two cases of anophthalmic enophthalmos. During the treatment of the first patient, unsatisfactory cosmetic problems including lower eyelid retraction, hypoglobus, and severe upper eyelid ptosis were revealed. Accordingly, a three-staged procedure was performed on the second patient, including autologous augmentation of the eye socket, correction of lower eyelid retraction with a cartilage graft, and a frontalis sling procedure to correct upper eyelid ptosis.
Highlights
Enophthalmos due to inappropriate primary repair of the eye socket is a serious cosmetic complaint of patients with anophthalmia
There were a number of issues worth noting in the treatment of two patients with anophthalmic enophthalmos
(b) Figure 6: Intraoperative views of the first surgery (Case 2). (a) Diced costal cartilage fragments wrapped with serratus fascia. (b) Prefabricated ball-shaped graft was placed into anophthalmic socket
Summary
Enophthalmos due to inappropriate primary repair of the eye socket is a serious cosmetic complaint of patients with anophthalmia. The goal of surgical correction of anophthalmic enophthalmos is to provide orbital symmetry relative to the unaffected side; there are several cosmetic concerns, including lower eyelid retraction, hypoglobus, and sever upper eyelid ptosis. Levator aponeurosis repair was performed under local anesthesia to correct the ipsilateral upper eyelid ptosis. During the first few months after aponeurotic surgery, upper eyelid ptosis recurred (Figure 3). The cosmetic defects were likely due to the lower eyelid retraction and downgazing of prosthetic eye. The recurrence of the upper eyelid ptosis may be associated with mechanical stress arising from insertion and removal of the prosthetic eye, which was heavier, thicker, and irregular (Figures 4(a) and 4(b))
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