Post-enucleation Socket Syndrome
 

Severe left post-enucleation socket syndrome. Mild right post-enucleation socket syndrome. Note the prominent upper lid sulcus.

Always suspect the presence of an arterficial eye if there were significant enophthalmos. The patient has an enophthalmos with an artificial eye in-situ. The skin crease is high with prosthesis.  The lower fornix is shallow and the lid is lax (pull on the lid to demonstrate these). Further examination: get the patient to look in different direction to check that both eyes move simultaneously mention that you like to remove the artificial eye and feel for the presence of any implant.

Questions:

1. What are the indications of enucleation?

Answer
The main indications are:
tumour removal such as choroidal melanoma
an unsightly blind eye
painful blind eye such as endophthalmitis in an eye with neovascular glaucoma
severely traumatized blind eye

2. What complications can occur following enucleation and how would you manage them?

Answer
Post-enucleation socket syndrome: deep superior sulcus and inferior displacement of the prosthesis due to volume loss and fat atrophy. Treatment consist of implant replacement and lower lid tightening for lower lid laxity
Ptosis from levator disinsertion or third nerve palsy. Replaced volume before lid operation as ptosis can occur due to volume loss
Contracted socket -abolition of conjunctival fornices so that a prosthesis cannot be retained. This is especially common with infection and radiotherapy. This can be treated with fornix deepening by using mucous membrane harvested from buccal mucosa.
Implant migration due to fat atrophy. Volume replacement may be needed
Implant extrusion from wound dehiscence. Treated by resuturing if the wound is small otherwise mucous membrane graft may be needed to close the wound.

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