Anophthalmic Socket Syndrome

Abstract

Anophthalmic socket syndrome, also known as post-enucleation socket syndrome (PESS), refers to a constellation of clinical findings that occur in the anophthalmic patient. These changes are primarily characterized by enophthalmos, superior sulcus hollowing, and eyelid malposition, and may be exacerbated by lack of an adequately sized orbital implant, in post-traumatic patients, and by pathophysiological changes associated with wearing an ocular prosthesis. Appropriate management of the anophthalmic patient involves a careful history and physical examination, as well as communication with an ocularist to discuss prosthetic and surgical planning. Nonsurgical orbital volume augmentation can be achieved with dermal fillers and fat augmentation, and the traditional surgical approach to orbital volume augmentation can be achieved via placement of a properly sized orbital implant with or without subperiosteal implant placement along the orbital floor. Once the enophthalmos and superior sulcus deformity have been addressed, a new prosthetic can be made, and any necessary ptosis repair or lower lid-tightening surgeries can be performed. This chapter will discuss the pathophysiology, clinical evaluation, and management of PESS.