Delayed Extrusion of Enophthalmic Wedge Implant

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Excerpt

An enophthalmic wedge is designed to mimic the shape of the orbital floor and restore the shape of the orbit.1 Most are made of high-density polyethylene. Typically, the implant will be used months to years after a fracture, which was not repaired at the time of injury. Complications associated with the enophthalmic wedge implants are rare.2,3 Here, we present a case report of a complication occurring 15 years following surgical intervention.
A 54-year-old female presented 15 years after motor vehicle accident resulting in multiple facial fractures including an orbital medial wall and floor fracture on the right. The patient did not have the fracture repaired at the time of injury and therefore had an enophthalmic wedge implant placed at some point shortly after the injury. She presented to our office with complains of discharge from the right eye and pain with extraocular movements. On examination, she was noted to have reduced vision of 20/400 in the right eye, severe limitation of upgaze on the right and cicatricial retraction of the right lower eyelid. A CT scan revealed an ossified wedge implant along the floor of the right orbit measuring 3 × 2.1 × 0.8 cm. The implant was noted to be protruding 4 mm anterior from the inferior orbital rim. Intraoperatively, the implant was noted to have significant septal scarring and scar tissue surrounding the inferior rectus. The implant was dissected from the cicatricial tissue and explanted. The fistula to the inferior lid was excised as well. Postoperatively, the patient’s supraduction improved from −3 to −1; however, she still had cicatricial retraction of the lower lid. This was subsequently repaired with posterior lamellar placement of Surgimend graft and temporary Frost suture. Postoperatively the patient did very well, with resolution retraction.
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