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Anophthalmia, Microphthalmia, Post Enucleation Socket Syndrome (PESS) and Socket reconstruction

Anophthalmia, Microphthalmia, Post Enucleation Socket Syndrome (PESS) and Socket reconstruction - What it is

Anophthalmia results when an eye is surgically removed for medical reasons.

Microphthalmia develops when an eye shrinks after severe infection or injury, also known as phthisis.

Although rare, both conditions may be congenital as part of a developmental anomaly.


Patient with the right eye removed

Anophthalmia, Microphthalmia, Post Enucleation Socket Syndrome (PESS) and Socket reconstruction - Symptoms

Patients who have anophthalmia and microphthalmia may suffer socket-(and ocular prosthesis) related problems – collectively known as Post Enucleation Socket Syndrome (PESS):

  • Sensitivity to the ocular prosthesis (false eye), discharge
  • Instability or difficulty in wearing an ocular prosthesis 
  • Superior sulcus deformity – the eye looks sunken, particularly for the area above the upper eyelid
  • Droopy upper eyelid (ptosis) and eyelashes (lash ptosis)
  • In-turning or out-turning of lower eyelid (entropion, ectropion)
  • Facial asymmetry (for congenital cases)

Anophthalmia, Microphthalmia, Post Enucleation Socket Syndrome (PESS) and Socket reconstruction - How to prevent?

Post-surgical PESS can be prevented by adequate volume replacement and meticulous tissue handling during enucleation or evisceration surgery.  Regular follow up with an ocularist/ocular prosthetic service will detect most early socket issues.  

Anophthalmia, Microphthalmia, Post Enucleation Socket Syndrome (PESS) and Socket reconstruction - Causes and Risk Factors

What are the risk factors? 
 
Inadequate volume replacement during enucleation/evisceration surgery.
Tissue wear and tear associated with years of or improper ocular prosthesis use.

Anophthalmia, Microphthalmia, Post Enucleation Socket Syndrome (PESS) and Socket reconstruction - Diagnosis

PESS can be detected through clinical examination and orbital imaging.

Anophthalmia, Microphthalmia, Post Enucleation Socket Syndrome (PESS) and Socket reconstruction - Treatments

Depending on specific symptoms, the following treatment may be prescribed:

  • Topical lubricant, antibiotic or anti-allergy eye drops
  • Polishing or remodelling of ocular prosthesis
  • Surgery to restore normal orbital volume and/or reconstruction of eyelid fornices with adequate mucosal lining (Secondary orbital implants or mucous membrane grafting)
 

Eye socket reconstruction is the reconstruction of a normal eye appearance in patients who have had their diseased eyes removed.  SNEC provides a dedicated clinic specialising in custom-made prosthesis eyes for our patients to improve their fit and cosmetic appearance. More complex cases may require several operations to achieve satisfactory results.

Anophthalmia, Microphthalmia, Post Enucleation Socket Syndrome (PESS) and Socket reconstruction - Preparing for surgery

Anophthalmia, Microphthalmia, Post Enucleation Socket Syndrome (PESS) and Socket reconstruction - Post-surgery care

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