Causes of contracted sockets include
radiation treatment (usually as treatment of a tumor that necessitated removal of the eye)
extrusion of an orbital implant
severe initial injury (alkali burns or extensive lacerations)
poor surgical techniques (excessive sacrifice or destruction of conjunctiva and Tenon capsule; traumatic dissection within the socket causing excessive scar tissue formation)
multiple ocular and/or socket operations
removal of the conformer or prosthesis for prolonged periods
Sockets are considered contracted when the fornices are too small to retain a prosthesis (Fig 8-10). Socket reconstruction procedures involve incision or excision of the scarred tissues and placement of a graft to enlarge the fornices. Full-thickness mucous membrane grafting is preferred as it allows the grafted tissue to match conjunctiva histologically. Amniotic membrane may also be used. Buccal mucosal grafts may be taken from the cheeks (avoid the duct from the parotid gland), the lower lip, or the upper lip, or from the hard palate for rigid tissue. Goblet cells and mucus production are preserved.
Figure 8-10 Contraction of the right anophthalmic socket.
(Courtesy of Keith D. Carter, MD.)
Contracture of the fornices alone (more common with the inferior fornix) is usually associated with milder degrees of socket contracture. In these cases, the buccal mucosal graft is placed in the defect, and a silicone sheet is attached by sutures to the superior or inferior orbital rim, depending on which fornix is involved. In 2 weeks, the sheet may be removed, and the prosthesis placed.
Excerpted from BCSC 2020-2021 series: Section 10 - Glaucoma. For more information and to purchase the entire series, please visit https://www.aao.org/bcsc.