Deep Superior Sulcus
Deep superior sulcus deformity is caused by insufficient orbital volume (Fig 8-4). The surgeon can correct this deformity by increasing the orbital volume through placement of a subperiosteal secondary implant posteriorly along the orbital floor. This implant pushes the initial implant anteriorly and orbital fat upward to fill out the superior sulcus. Dermisfat grafts may be implanted in the upper eyelid to fill out the sulcus; however, eyelid contour and function may be damaged, and the graft may undergo resorption. Superior sulcus deformity can also be corrected with replacement of the original implant with a larger secondary implant. Alternatively, modification of the ocular prosthesis may be used to correct a deep superior sulcus.
A related problem occurs when the superior conjunctival fornix is too deep. This leads to retention and buildup of mucus and debris, causing chronic discharge and infection. This condition, which is called giant fornix syndrome, is treated with a superior conjunctival resection.
Farmer LD, Rajak SN, McNab AA, Hardy TG, Selva D. Surgical correction of giant fornix syndrome. Ophthalmic Plast Reconstr Surg. 2016;32(2):142–144.
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.