The Müller muscle flap for repair of an exposed hydroxyapatite orbital implant.

A 36-year-old woman was experiencing discomfort and discharge after placement of an orbital implant 1 year previously. Her ocular history included iridocorneal endothelial syndrome, requiring two trabeculectomies, the last of which included the use of 5-fluorouracil (5-FU). After enucleation, a hydroxyapatite orbital implant was placed. Shortly thereafter, an implant exposure developed and continued to enlarge to 11 mm even after her ocularist had elevated the prosthesis off the exposed area and surrounding conjunctiva. Magnetic resonance imaging with gadolinium enhancement was not obtained because of the prohibitive cost. Fourteen months later, a vascularized Müller muscle pedicle flap was devised and tunneled underneath the existing conjunctiva to cover the defect. The overlying levator was undisturbed; however, transient ptosis occurred that returned to baseline after 2 weeks. This is a new and novel approach to restore orbital implant exposure and may be most helpful after antimetabolite treatment to the conjunctiva or radiation to the orbit.