Anophthalmia, Microphthalmia, Post Enucleation Socket Syndrome (PESS) and Socket reconstruction

Symptoms | Treatments

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What is

Symptoms

How to prevent

Causes and Risk Factors

Diagnosis

Treatment

What is - Anophthalmia, Microphthalmia, Post Enucleation Socket Syndrome (PESS) and Socket reconstruction

Anophthalmia results when an eye is surgically removed for medical reasons.

Microphthalmia develops when an eye shrinks after severe infection or injury, also known as phthisis.

Although rare, both conditions may be congenital as part of a developmental anomaly.

Patient with the right eye removed

Symptoms of Anophthalmia, Microphthalmia, Post Enucleation Socket Syndrome (PESS) and Socket reconstruction

Patients who have anophthalmia and microphthalmia may suffer socket-(and ocular prosthesis) related problems – collectively known as Post Enucleation Socket Syndrome (PESS):

Sensitivity to the ocular prosthesis (false eye), discharge
Instability or difficulty in wearing an ocular prosthesis
Superior sulcus deformity – the eye looks sunken, particularly for the area above the upper eyelid
Droopy upper eyelid (ptosis) and eyelashes (lash ptosis)
In-turning or out-turning of lower eyelid (entropion, ectropion)
Facial asymmetry (for congenital cases)

Anophthalmia, Microphthalmia, Post Enucleation Socket Syndrome (PESS) and Socket reconstruction - How to prevent

Post-surgical PESS can be prevented by adequate volume replacement and meticulous tissue handling during enucleation or evisceration surgery. Regular follow up with an ocularist/ocular prosthetic service will detect most early socket issues.

Anophthalmia, Microphthalmia, Post Enucleation Socket Syndrome (PESS) and Socket reconstruction - Causes and Risk Factors

What are the risk factors?

Inadequate volume replacement during enucleation/evisceration surgery.

Tissue wear and tear associated with years of or improper ocular prosthesis use.

Diagnosis of Anophthalmia, Microphthalmia, Post Enucleation Socket Syndrome (PESS) and Socket reconstruction

PESS can be detected through clinical examination and orbital imaging.

Treatment for Anophthalmia, Microphthalmia, Post Enucleation Socket Syndrome (PESS) and Socket reconstruction

Depending on specific symptoms, the following treatment may be prescribed:

Topical lubricant, antibiotic or anti-allergy eye drops
Polishing or remodelling of ocular prosthesis
Surgery to restore normal orbital volume and/or reconstruction of eyelid fornices with adequate mucosal lining (Secondary orbital implants or mucous membrane grafting)

Eye socket reconstruction is the reconstruction of a normal eye appearance in patients who have had their diseased eyes removed. SNEC provides a dedicated clinic specialising in custom-made prosthesis eyes for our patients to improve their fit and cosmetic appearance. More complex cases may require several operations to achieve satisfactory results.

Contributed by

Oculoplastic Department, Singapore National Eye Centre

The information provided is not intended as medical advice. Terms of use. Information provided by SingHealth.

Condition Treated At

Department

Plastic and Reconstructive Surgery