Abstract
The ideal anophthalmic socket has the following characteristics: a well-positioned implant of adequate volume, normal upper and lower eyelids with good height and tone, and a lining of mucous membrane with deep superior and inferior fornices to hold the ocular prosthesis. Sockets can become scarred and contracted due to trauma, recurrent infections and inflammations, chemical or thermal injuries, implant exposures, and radiation therapy. Mild contracture leads to entropion with poor cosmesis and crusting. Moderate contracture results in shallowing of the fornices with inability to close the eyelids and often difficulty in maintaining the artificial eye. Severe contracture results in complete loss of fornices, horizontal shortening, and inability to place a prosthesis. This chapter covers the causes and prevention of socket contracture as well as surgical correction. Methods include grafting with mucous membrane, amniotic membrane, dermis fat, and skin. Fornix-deepening sutures as well as fixated conformers are also discussed.