The possible complications of anophthalmic eye sockets can occur due to many different pathomechanisms. A differentiation is made between allergic, infectious, inflammatory or mechanical causes. This article gives an overview on the different etiologies of socket complications with their pathophysiology and treatment options.

Die möglichen Komplikationen der anophthalmischen Orbita können auf Basis unterschiedlicher Pathomechanismen entstehen. Unterschieden werden allergische, infektiöse, entzündliche oder mechanische Ursachen. In dieser Übersichtsarbeit werden die unterschiedlichen Ätiologien beleuchtet sowie deren therapeutische Ansätze diskutiert.

Centrum für Integrierte Onkologie Aachen Bonn Köln Düsseldorf Köln Deutschland

Klinik für Augenheilkunde Universitätskrankenhaus Ostrava Ostrava Tschechien

Medizinische Fakultät Abteilung für kraniofaziale Chirurgie Universität zu Ostrava Ostrava Tschechien

Zentrum für Augenheilkunde Medizinische Fakultät und Uniklinik Köln Universität zu Köln Kerpener Str 62 50937 Köln Deutschland

Zobrazit více v PubMed

Aggarwal H, Singh SV, Kumar P, Kumar Singh A (2015) Prosthetic rehabilitation following socket reconstruction with blair-brown graft and conformer therapy for management of severe post-enucleation socket syndrome—A clinical report. J Prosthodont 24:329–333

AlHassan S, Galindo-Ferreiro A, Khandekar R, AlShaikh O, Schellini SA (2018) Deepening fornix technique using central split-medium thickness skin graft to treat contracted anophthalmic sockets. J Craniofac Surg 29:1607–1611

Allen L, Kolder HE, Bulgarelli EM, Bulgarelli DM (1980) Artificial eyes and tear measurements. Ophthalmology 87:155–157

Anderson RL (1981) Tarsal strip procedure for correction of eyelid laxity and canthal malposition in the anophthalmic socket. Ophthalmology 88:895–903

Bailey CS, Buckley RJ (1991) Ocular prostheses and contact lenses. I—Cosmetic devices. BMJ 302:1010–1012

Bilkhu P, Wolffsohn JS, Taylor D, Gibson E, Hirani B, Naroo SA (2013) The management of ocular allergy in community pharmacies in the United Kingdom. Int J Clin Pharm 35:190–194

Bischoff G (2014) Giant papillary conjunctivitis. Klin Monbl Augenheilkd 231:518–521

Bohman E, Roed Rassmusen ML, Kopp ED (2014) Pain and discomfort in the anophthalmic socket. Curr Opin Ophthalmol 25:455–460

Bozkurt B, Akyurek N, Irkec M, Erdener U, Memis L (2007) Immunohistochemical findings in prosthesis-associated giant papillary conjunctivitis. Clin Exp Ophthalmol 35:535–540

Christensen JN, Fahmy JA (1974) The bacterial flora of the conjunctival anophthalmic socket in glass prosthesis-carriers. Acta Ophthalmol (Copenh) 52:801–809

Colorado LH, Alzahrani Y, Pritchard N, Efron N (2016) Time course of changes in goblet cell density in symptomatic and asymptomatic contact lens wearers. Invest Ophthalmol Vis Sci 57:2888–2894

Crochelet O, Maalouf T, Duron S, Froussart F, Rigal-Sastourne JC, George JL (2012) Efficacy and tolerability of highly crosslinked hyaluronic acid injections in the management of the enophthalmous orbit. J Fr Ophtalmol 35(441):e441–447

Detorakis ET, Engstrom RE, Straatsma BR, Demer JL (2003) Functional anatomy of the anophthalmic socket: insights from magnetic resonance imaging. Invest Ophthalmol Vis Sci 44:4307–4313

Ding J, Ma X, Xin Y, Li D (2018) Correction of lower eyelid retraction with hard palate graft in the anophthalmic socket. Can J Ophthalmol 53:458–461

Franca IS, Medrado J, Franca VP, Soares EJ (2011) Treatment of dry anophthalmic cavities with labial salivary glands transplantation. Arq Bras Oftalmol 74:425–429

Groot AL, Remmers JS, Kloos RJ, Saeed P, Hartong DT (2021) Recurrent contracted sockets treated with personalized, three-dimensionally printed conformers and buccal grafts. Eur J Ophthalmol. https://doi.org/10.1177/11206721211000013 DOI

Guberina C, Hornblass A, Meltzner MA, Soarez V, Smith B (1983) Autogenous dermis-fat orbital implantation. Arch Ophthalmol 101:1586–1590

Han LS, Keillor RB, Weatherhead RG (2021) Case series of shrinking hydroxyapatite orbital implants. Br J Ophthalmol 105:1338–1340

Hatt M (1992) Orbitoplasty in patients with artificial eyes. Klin Monbl Augenheilkd 200:424–427

Heindl LM, Rokohl AC (2021) Orbital implants: material matters. Br J Ophthalmol 105:1337

Hintschich C, Beyer-Machule C (1996) Dermis-Fett-Transplantat als primäres und sekundäres Orbitaimplantat – Komplikationen und Ergebnisse. Ophthalmologe 93:617–622

Hintschich C, Zonneveld F, Koornneef L (2001) Normal orbital volumes and its pathology in orbital socket surgery. Oper Tech Oculoplastic Orbital Reconstr Surg 4(1):3–14

Ibrahiem MF, Abdelaziz ST (2016) Shallow inferior conjunctival Fornix in contracted socket and anophthalmic socket syndrome: A novel technique to deepen the Fornix using fascia Lata strips. J Ophthalmol. https://doi.org/10.1155/2016/3857579 DOI

Inchingolo F, Tatullo M, Pacifici A, Gargari M, Inchingolo AD, Inchingolo AM, Dipalma G, Marrelli M, Abenavoli FM, Pacifici L (2012) Use of dermal-fat grafts in the post-oncological reconstructive surgery of atrophies in the zygomatic region: clinical evaluations in the patients undergone to previous radiation therapy. Head Face Med 8:33

Jang SY, Lee SY, Yoon JS (2013) Meibomian gland dysfunction in longstanding prosthetic eye wearers. Br J Ophthalmol 97:398–402

Kenny SE, Tye CB, Johnson DA, Kheirkhah A (2020) Giant papillary conjunctivitis: A review. Ocul Surf 18:396–402

Keseru M, Grosse Darrelmann B, Green S, Galambos P (2015) Post enucleation socket syndrome—new and established surgical solutions. Klin Monbl Augenheilkd 232:40–43

Kim CY, Woo YJ, Lee SY, Yoon JS (2014) Postoperative outcomes of anophthalmic socket reconstruction using an autologous buccal mucosa graft. J Craniofac Surg 25:1171–1174

Kim JH, Lee MJ, Choung HK, Kim NJ, Hwang SW, Sung MS, Khwarg SI (2008) Conjunctival cytologic features in anophthalmic patients wearing an ocular prosthesis. Ophthalmic Plast Reconstr Surg 24:290–295

Kim S, Lee S, Chang H, Kim M, Kim MJ, Kim KH (2019) In vivo fluorescence imaging of conjunctival goblet cells. Sci Rep 9:15457

Kim SS, Kawamoto HK, Kohan E, Bradley JP (2010) Reconstruction of the irradiated orbit with autogenous fat grafting for improved ocular implant. Plast Reconstr Surg 126:213–220

Ko JS, Seo Y, Chae MK, Jang SY, Yoon JS (2018) Effect of topical loteprednol etabonate with lid hygiene on tear cytokines and meibomian gland dysfunction in prosthetic eye wearers. Eye (Lond) 32:439–445

Koch KR, Trester W, Muller-Uri N, Trester M, Cursiefen C, Heindl LM (2016) Ocular prosthetics. Fitting, daily use and complications. Ophthalmologe 113:133–142

Krishna G (1980) Contracted sockets—I (aetiology and types). Indian J Ophthalmol 28:117–120

Kronish JW, Gonnering RS, Dortzbach RK, Rankin JGH, Reid DL, Phernetton TN (1990) The pathophysiology of the anophthalmic socket. Part I. Analysis of orbital blood flow. Ophthal Plast Reconstr Surg 6:77–87

Kronish JW, Gonnering RS, Dortzbach RK, Rankin JGH, Reid DL, Phernetton TN, Pitts WC, Berry GJ (1990) The pathophysiology of the anophthalmic socket. Part II. Analysis of orbital fat. Ophthal Plast Reconstr Surg 6:88–95

Kuijten MMP, Remmers JS, Mourits DL, de Graaf P, Hartong DT (2017) Three-Dimensionally printed conformers for treatment of congenital anophthalmos. Ophthalmic Plast Reconstr Surg 33:394–395

Kumar S, Sugandhi P, Arora R, Pandey PK (2006) Amniotic membrane transplantation versus mucous membrane grafting in anophthalmic contracted socket. Orbit 25:195–203

Kwitko GM, Patel BC (2022) Blepharoplasty Ptosis surgery. StatPearls, Treasure Island

Li T, Shen J, Duffy MT (2001) Exposure rates of wrapped and unwrapped orbital implants following enucleation. Ophthalmic Plast Reconstr Surg 17:431–435

Mandour SS, Elmazar HM, Marey HM, Rahman AK, Sakr RA (2016) Mucous membrane grafting augmented with topical mitomycin C application in contracted socket repair surgeries. J Ocul Pharmacol Ther 32:691–694

Mattout HK, Fouda SM, Al-Nashar HY (2021) Evaluation of topical mitomycin‑C eye drops after reconstructive surgery for anophthalmic contracted socket. Clin Ophthalmol 15:4621–4627

McCord CD, Moses JL (1979) Exposure of the inferior orbit with fornix incision and lateral canthotomy. Ophthalmic Surg 10:53–63

McLaughlin S, Welch J, MacDonald E, Mantry S, Ramaesh K (2014) Xerophthalmia—A potential epidemic on our doorstep? Eye (Lond) 28:621–623

Meisler DM, Krachmer JH, Goeken JA (1981) An immunopathologic study of giant papillary conjunctivitis associated with an ocular prosthesis. Am J Ophthalmol 92:368–371

Messmer EM (2015) The pathophysiology, diagnosis, and treatment of dry eye disease. Dtsch Arztebl Int 112:71–81 (quiz 82)

Mouriaux F (2022) How to analyze conjunctival inflammation in dry anophthalmic socket syndrome (DASS)? Graefes Arch Clin Exp Ophthalmol. https://doi.org/10.1007/s00417-022-05899-w DOI

Nentwich MM, Schebitz-Walter K, Hirneiss C, Hintschich C (2014) Dermis fat grafts as primary and secondary orbital implants. Orbit 33(1):33–38

Patel V, Allen D, Morley AM, Frcophth RM (2009) Features and management of an acute allergic response to acrylic ocular prostheses. Orbit 28:339–341

Pine K, Sloan B, Stewart J, Jacobs RJ (2011) Concerns of anophthalmic patients wearing artificial eyes. Clin Exp Ophthalmol 39:47–52

Pine K, Sloan B, Stewart J, Jacobs RJ (2012) A survey of prosthetic eye wearers to investigate mucoid discharge. Clin Ophthalmol 6:707–713

Pine KR, Sloan B, Han KI, Swift S, Jacobs RJ (2013) Deposit buildup on prosthetic eye material (in vitro) and its effect on surface wettability. Clin Ophthalmol 7:313–319

Pine KR, Sloan B, Jacobs RJ (2012) Biosocial profile of New Zealand prosthetic eye wearers. N Z Med J 125:29–38

Pine KR, Sloan B, Jacobs RJ (2012) Deposit buildup on prosthetic eyes and implications for conjunctival inflammation and mucoid discharge. Clin Ophthalmol 6:1755–1762

Pine KR, Sloan B, Stewart J, Jacobs RJ (2013) The response of the anophthalmic socket to prosthetic eye wear. Clin Exp Optom 96:388–393

Pine KR, Sloan BH, Jacobs RJ (2013) A proposed model of the response of the anophthalmic socket to prosthetic eye wear and its application to the management of mucoid discharge. Med Hypotheses 81:300–305

Pine KR, Sloan BH, Jacobs RJ (2015) Clinical ocular prosthetics, 1. Aufl. Springer, Cham

Pine NS, de Terte I, Pine K (2017) The impact of eye loss and prosthetic eye wear on recreational, occupational and social areas of functioning. J Ophthalmol Vis Sci 2:1016

Pine NS, de Terte I, Pine K (2017) Time heals: an investigation into how anophthalmic patients feel about eye loss and wearing a prosthetic eye. J Ophthalmol Vis Sci 2:1018

Pine NS, de Terte I, Pine KR (2017c) An investigation into discharge, visual perception, and appearance concerns of prosthetic eye wearers. Orbit 36:401–406

Quaranta-Leoni FM (2008) Treatment of the anophthalmic socket. Curr Opin Ophthalmol 19:422–427

Quaranta-Leoni FM, Fiorino MG, Quaranta-Leoni F, Di Marino M (2021) Anophthalmic socket syndrome: Prevalence, impact and management strategies. Clin Ophthalmol 15:3267–3281

Rokohl AC, Adler W, Koch KR, Mor JM, Jia R, Trester M, Pine NS, Pine KR, Heindl LM (2019) Cryolite glass prosthetic eyes-the response of the anophthalmic socket. Graefes Arch Clin Exp Ophthalmol 257:2015–2023

Rokohl AC, Koch KR, Adler W, Trester M, Trester W, Pine NS, Pine KR, Heindl LM (2018) Concerns of anophthalmic patients—A comparison between cryolite glass and polymethyl methacrylate prosthetic eye wearers. Graefes Arch Clin Exp Ophthalmol 256:1203–1208

Rokohl AC, Koch KR, Trester M, Heindl LM (2018) Cryolite glass ocular prostheses and coralline hydroxyapatite implants for eye replacement following enucleation. Ophthalmologe 115:793–794

Rokohl AC, Koch KR, Trester M, Trester W, Pine KR, Heindl LM (2018) Concerns of anophthalmic patients wearing cryolite glass prosthetic eyes. Ophthalmic Plast Reconstr Surg 34:369–374

Rokohl AC, Kopecky A, Trester M, Wawer Matos PA, Pine KR, Heindl LM (2022) Post-enucleation socket syndrome—A novel pathophysiological definition. Graefes Arch Clin Exp Ophthalmol 260(8):2427–2431

Rokohl AC, Mor JM, Trester M, Koch KR, Heindl LM (2019) Rehabilitation of anophthalmic patients with prosthetic eyes in Germany today—Supply possibilities, daily use, complications and psychological aspects. Klin Monbl Augenheilkd 236:54–62

Rokohl AC, Pine NS, Adler W, Bartenschlager LAK, Wawer Matos PA, Trester M, Pine KR, Pförtner TK, Heindl LM (2022) Health literacy in patients wearing prosthetic eyes: A prospective cross-sectional study. Curr Eye Res 2:1–7

Rokohl AC, Trester M, Pine KR, Heindl LM (2020) Prevention of socket complications in anophthalmic patients. Curr Eye Res 45:1625–1626

Rokohl AC, Trester M, Guo Y, Adler W, Jaeger VK, Loreck N, Mor JM, Pine KR, Heindl LM (2020) Dry anophthalmic socket syndrome—Standardized clinical evaluation of symptoms and signs. Ocul Surf 18:453–459

Rokohl AC, Trester M, Naderi P, Loreck N, Zwingelberg S, Bucher F, Pine KR, Heindl LM (2021) Dry anophthalmic socket syndrome—Morphological alterations in meibomian glands. Eye (Lond) 35:3358–3366

Rokohl AC, Wall K, Trester M, Wawer Matos PA, Guo Y, Adler W, Pine KR, Heindl LM (2022) Novel point-of-care biomarkers of the dry anophthalmic socket syndrome: tear film osmolarity and matrix metalloproteinase 9 immunoassay. Graefes Arch Clin Exp Ophthalmol. https://doi.org/10.1007/s00417-022-05895-0 DOI

Ruiters S, Mombaerts I (2021) The prevalence of anophthalmic socket syndrome and its relation to patient quality of life. Eye (Lond) 35:1909–1914

Schittkowski MP, Guthoff RF (2006) Injectable self inflating hydrogel pellet expanders for the treatment of orbital volume deficiency in congenital microphthalmos: preliminary results with a new therapeutic approach. Br J Ophthalmol 90:1173–1177

Shah CT, Hughes MO, Kirzhner M (2014) Anophthalmic syndrome: a review of management. Ophthalmic Plast Reconstr Surg 30:361–365

Shapira Y, Worrell E, Litwin AS, Malhotra R (2021) The UK National Artificial Eye Questionnaire study: Predictors of artificial eye wearers’ experience part 1‑comfort and satisfaction. Eye (Lond) 35:2233–2240

Smit TJ, Koornneef L, Zonneveld FW, Groet E, Otto AJ (1990) Computed tomography in the assessment of the postenucleation socket syndrome. Ophthalmology 97:1347–1351

Smith B, Petrelli R (1978) Dermis-fat-graft as a movable implant within the muscle cone. Am J Ophthalmol 85:62

Srinivasan BD, Jakobiec FA, Iwamoto T, DeVoe AG (1979) Giant papillary conjunctivitis with ocular prostheses. Arch Ophthalmol 97:892–895

Swann PG (2001) Giant papillary conjunctivitis associated with an ocular prosthesis. Clin Exp Optom 84:293–295

Tawfik HA, Abdulhafez MH, Fouad YA, Rashed HO, Osman WM (2016) Revisiting the role of the myofibroblast in socket surgery: an immunohistochemical study. Ophthalmic Plast Reconstr Surg 32:292–295

Tawfik HA, Raslan AO, Talib N (2009) Surgical management of acquired socket contracture. Curr Opin Ophthalmol 20:406–411

Thiesmann R, Anagnostopoulos A, Stemplewitz B (2018) Long-term results of the compatibility of a coralline hydroxyapatite implant as eye replacement. Ophthalmologe 115:131–136

Tyers AG, Collin JR (1982) Orbital implants and post enucleation socket syndrome. Trans Ophthalmol Soc U K 102(Pt 1):90–92

Vagefi MR (2013) Minimally invasive approaches to orbital volume augmentation. Int Ophthalmol Clin 53:67–86

Vagefi MR, McMullan TF, Burroughs JR, Georgescu D, McCann JD, Anderson RL (2011) Orbital augmentation with injectable calcium hydroxylapatite for correction of postenucleation/evisceration socket syndrome. Ophthalmic Plast Reconstr Surg 27:90–94

Vasquez RJ, Linberg JV (1989) The anophthalmic socket and the prosthetic eye. A clinical and bacteriologic study. Ophthalmic Plast Reconstr Surg 5:277–280

Vistnes LM (1976) Mechanism of upper lid ptosis in the anophthalmic orbit. Plast Reconstr Surg 58:539–545

Wladis EJ, Aakalu VK, Sobel RK, Yen MT, Bilyk JR, Mawn LA (2018) Orbital implants in enucleation surgery: a report by the American Academy of Ophthalmology. Ophthalmology 125:311–317

Yang F, Li Z, Deng Y (2020) A custom-made conformer wrapped in lower oral mucosa for the correction of severely contracted socket. Eur J Ophthalmol. https://doi.org/10.1177/1120672120974940 DOI

Zhao H, Chen JY, Wang YQ, Lin ZR, Wang S (2016) In vivo confocal microscopy evaluation of meibomian gland dysfunction in dry eye patients with different symptoms. Chin Med J (Engl) 129:2617–2622