Reconstruction of the contracted ocular socket.

Totally contracted ocular sockets are difficult to reconstruct and many patients resort to wearing a black patch. One reason for surgical failure is that many popular techniques attach a mucous membrane or a skin-lined vertical stent to the superior or inferior orbital rim. This produces a vertical space that commonly shrinks and becomes too small to retain an artificial eye. The normal anatomy of the ocular cul-de-sac is C-shaped rather than vertical. It passes under the orbital roof superiorly and over the floor inferiorly. A technique has been devised in which the mid-aspect of a custom-made C-shaped mucous membrane-lined conformer is secured to the superior and inferior orbital rims. This attachment forces the posterior periphery of the conformer deep into the socket to form a space that stimulates the normal anatomy of the ocular cul-de-sac. The described technique has been successful in producing a spacious cul-de-sac in 36 patients with total socket contractures. A modification of the technique has been successful in treating 12 patients with partial contractures. All patients have easily retained an artificial eye after operation.