Congenital under-development of the orbit is most frequently associated with under-development, or complete absence of the eye (congenital microphthalmos). In such cases it is important to start with combined prosthetic and surgical treatment as soon as possible, in order to stimulate the growth of bony and soft tissue structures of the orbit. In severe cases, failure to treat may lead to facial asymetry.

 

 
Congenital abscence of the right eye, with consequential under-development of the orbit
 
3D reconstruction of the bony structures of the face, derived from high resolution CT (computerized tomography)

 

In certain cases, due to trauma or disease of an eye, surgical removal is warranted, because of the threat to the other eye, life threatening disease (intraocular tumour), or because of the negative effect on the quality of life due to disfigurement or chronic pain. When an eye is removed, an orbital implant is inserted into the orbit, to which the oculomotor muscles are attached. After approximately one month, an ocular prosthesis (artificial eye) is fitted. The orbital implant helps the prosthesis move synchronous with the other eye.

If an orbital implant was not inserted when the eye was surgicaly removed, during time, the volume deficit causes certain changes in the soft tissues of the orbit,  which have a negative effect on the esthetic and functional aspects of prosthetic treatment.

 

 
Appearance of the right orbit after removal of the eye without orbital implant pacement. There is an obvious „emptyness“ in the orbit, which the ocular prosthesis alone cannot compensate.

 

In such cases it is necessary to replace the lost volume by a secondary orbital implant. Modern orbital implants are mostly spherical, made of different synthetic materials. The size (diameter) of the implant is calculated, prior to surgery, by a special algorhythm.

If, due to scarring of the orbital soft tissues, the socket cannot accomodate a prosthesis, surgical reconstruction is indicated. The procedures performed, usually involve transplanting tissues from other parts of the body, such as oral mucosa or buttock fat.

 

 
The right socket is contracted, thus there is not enough space for the ocular prosthesis, which has a tendency to fall out

 

 




Eyelids and the periocular region | Lacrimal (tear) drainage pathways | The eye socket – orbit | Anesthesia for oculoplastic surgical procedures | Ocular prosthetics

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