Secondary Orbital Implants, Dermis-Fat Graft, and Socket Volume Enhancement Techniques

Anophthalmic socket syndrome determines facial deformity, and may lead to poor psychological outcomes. Appropriate care is essential, as adequate surgical procedures and correct wearing of the prosthesis improve the quality of life of anophthalmic patients. Secondary orbital ball implantation may restore adequate orbital volume and may improve the motility of the prosthesis when no implant had been positioned at the time of primary surgery. Current clinical evidence does not support a specific orbital implant. Dermis fat graft can address the volume deficit in case of explantation of exposed implants, and when extra lining is needed to avoid socket contraction in both children and adults. Residual volume deficit may be corrected with an orbital floor implant and with a dermis-fat graft in the superior sulcus. Minimally invasive techniques offer a reasonable alternative in cases of both phthisis bulbi and post enucleation socket syndrome. Lipofilling with autologous fat carries no antigenic potential, but there is a degree of unpredictability due to the variability of fat resorption. Dermal fillers are currently used for orbital volume augmentation as a suitable non-surgical alternative, and hyaluronic acid gels offer the potential for reversibility by injecting hyaluronidase if required. However, filler absorption in the orbit appears to be faster than in the dermis, and repeated treatments could be a potential source of inflammation.