Post Enucleation Socket Syndrome

Post-enucleation socket syndrome (PESS) is characterised by volume deficiency and alterations of the orbital contents in the acquired anophthalmic socket, resulting in enophthalmos, deep upper eyelid sulcus, and eyelid malpositions. The loss of the eyeball accounts for most of the soft tissue volume deficit, while other factors such as chronic inflammation, orbital infection, trauma, radiation, and secondary orbital implantation can also play a role. PESS may be associated with varying degrees of socket contraction and forniceal shortening. Primary orbital implants are the most effective means of preventing PESS. Management options include prosthetic adjustments, orbital volume replacement with a secondary implant, correction of eyelid malposition (such as horizontal lower eyelid tightening, ptosis correction, or contralateral camouflaging blepharoplasty), and of any concurrent socket contraction.