Orbital Exenteration and Rehabilitation of the Exenterated Socket

Abstract

Orbital exenteration is the surgical removal of orbital contents and periorbital structures. The majority of orbital exenterations are performed to remove malignant tumors, including primary epithelial tumors, rhabdomyosarcoma, retinoblastoma, and uveal melanoma. Other potential indications for orbital exenteration include severe and uncontrollable pain or deformity caused by extreme cases of sclerosing orbital pseudotumor, Graves’ ophthalmopathy, neurofibromatosis, and socket contracture. Generally, orbital exenteration is subclassified into three types: standard, eyelid-sparing, and extended orbital exenteration. The type of exenteration performed, as well as the planned reconstruction, depends upon the extent of the oncologic defect. The primary goal of reconstruction is to line the orbital cavity with durable tissue and to exclude the nasal and/or sinus cavities when the medial or inferior orbital wall has been removed and to protect the brain when the orbital roof has been removed. The reconstructed orbit will need to be able to tolerate radiation therapy (if planned) and to accommodate an orbital prosthesis if one is desired by the patient.