Anophthalmic Socket Surgical Risks

Side Effects / Complications of Enucleation or Evisceration surgery

  • When an eye is removed, {the} patient loses all vision and {the} cosmetic use of {the} globe. Described complications include hemorrhage, infection and extrusion of {the} implant.
  • Most patients with post-operative hemorrhage are either on blood thinners (e.g coumadin, plavix, heparin or aspirin) or are known to have a bleeding disorder. Such hemorrhages can be painful, but intervention is rarely helpful. Patients are typically treated with analgesic medications (pain-killers).
  • Orbital Infections are very rare, but are more common with integrated orbital implants. Most secondary orbital infections can be managed with antibiotics, covering or surgical removal of {the} orbital implant.
  • Implant extrusions can be managed by surgical replacement of {the} orbital implant

    Normal Volumes of {the} Orbit

    • Adult orbital volume ranges from 24 to 30 ml
    • Female orbital volume is approximately 2 mm less than male adults
    • Each orbit contains approximately 10 ml of fat; extraocular muscles account for 5 ml of volume and {the} normal eyeball accounts for approximately 7 ml.

    Following enucleation there is a decrease in volume as well as changes in structure which give rise to what has been termed “post-enucleation socket syndrome.”

    • This involves enophthalmos, a deep upper eyelid sulcus, lower eyelid laxity with shallow fornix with possibly Ptosis or lid retraction.
    • When an eye is removed, recall there is a 7 ml volume loss; however, {the} most commonly used 18 ml sphere replaces a volume of approximately 3 mm while a 16 mm sphere replaces a volume of 2 ml. A 20 mm sphere provides 4.1 ml of volume.
    • The situation is made worse by orbital fat atrophy of up to 3 ml.
    • It is unclear whether fat atrophy recurs as a result of reduction of blood supply or due to mechanical manipulation during surgical enucleation.
    • Bony orbital volumes are also noted to be smaller in patients who have had long-standing enophthalmia.

Potential Complications

Exposed Orbital Implant

The Photograph on {the} left is an exposed orbital implant. The implant, once exposed, is at risk for extrusion. If {the} exposure is limited it could be repaired surgically. Otherwise, it my need to be removed, and a dermal fat graft procedure performed

is {the} result of {the} following:


Deep Sulcus


  • Loss of volume
  • Structural changes
  • Fat atrophy
  • Retraction or changes in extraocular muscles
  • Loss of support of {the} levator complex

Poorly Fitting:


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