Orbital implants are medical devices designed to replace the volume of a missing eye within the eye socket. These implants serve a purpose in restoring the aesthetic appearance of the face after an eye has been surgically removed or has failed to develop. They provide a base for a prosthetic eye, allowing it to move in a way that mimics natural eye movement. This intervention helps individuals regain facial symmetry and improve their quality of life.
Understanding Orbital Implants
Orbital implants are spherical or ovoid devices placed within the anophthalmic socket, the space left after an eye’s removal. These implants are designed to fit within this space, maintaining the shape and structure of the eye socket. They come in various sizes, ranging from 16 to 22 millimeters in diameter, to accommodate different patient anatomies and orbital volumes.
The materials used for orbital implants include silicone, porous polyethylene, and hydroxyapatite. Silicone implants are non-porous spheres, while porous materials like polyethylene and hydroxyapatite feature an interconnected network of pores. This porous structure allows for the ingrowth of the body’s own tissues and blood vessels, which helps anchor the implant and can improve the movement of a prosthetic eye placed over it.
Why Orbital Implants Are Used
Orbital implants are used following the surgical removal of an eye, a procedure known as enucleation or evisceration. Enucleation involves the complete removal of the eyeball, often necessitated by severe trauma, intraocular tumors like retinoblastoma, or irreparable damage from infections. Evisceration removes the internal contents of the eye while preserving the outer scleral shell, which can then cover the implant.
These implants address both the functional and aesthetic consequences of eye loss. Without an implant, the eye socket can shrink, leading to a sunken appearance of the eyelid and face. By restoring volume, the implant helps maintain the natural contour of the face and supports the eyelids, preventing facial asymmetry. This physical support also provides a stable foundation for an ocular prosthesis, a custom artificial eye that fits over the implant to enhance the cosmetic outcome.
Orbital implants also play a role when an eye did not develop congenitally, promoting proper orbital growth in children. The implant acts as a space maintainer, preventing the surrounding bone structure from deforming due to the eye’s absence. The goal is to create a well-formed, natural-appearing socket that can comfortably retain a prosthetic eye and allow for a range of motion closely resembling that of a natural eye.
The Surgical Procedure
Receiving an orbital implant begins with a pre-surgical evaluation. This involves medical imaging, such as CT scans or MRIs, to assess the orbital anatomy and determine the appropriate implant size and type. Patients also consult with their ophthalmic surgeon to discuss the procedure, potential risks, and expected outcomes.
On the day of surgery, general anesthesia is administered to ensure comfort and immobility throughout the procedure. The surgical approach depends on whether the eye is being enucleated or eviscerated. During enucleation, the extraocular muscles, which control eye movement, are detached from the eye and may then be reattached directly to the orbital implant or to a wrapping material placed over the implant.
After the implant is positioned within the eye socket, the surrounding tissues and conjunctiva are closed over it. This “buries” the implant, separating it from the external environment to minimize the risk of infection and exposure. The surgical procedure takes between one to two hours, depending on the complexity of the case and the technique employed.
Life After Orbital Implant Surgery
Following orbital implant surgery, immediate recovery involves managing discomfort with prescribed pain medication and applying cold compresses to reduce swelling. Patients experience bruising and swelling around the eye socket, which gradually subsides over several weeks. A conformer, a clear plastic shell, is placed in the socket immediately after surgery to help maintain its shape during the healing phase.
Follow-up appointments with the surgeon are scheduled to monitor healing, remove sutures, and address any concerns. The healing process takes about six to eight weeks before a prosthetic eye can be fitted. During this time, the implant integrates with the surrounding tissues, which allows for fibrovascular ingrowth.
Once the socket has fully healed, a custom prosthetic eye is created by an ocularist to match the remaining natural eye in color, shape, and size. Long-term care involves regular cleaning of the prosthetic eye and periodic check-ups with the ocularist and ophthalmologist to ensure proper fit and address any changes in the socket. Maintaining good hygiene is important to prevent irritation or infection in the socket.