Enophthalmic Blind Immobile Eye with Ptosis

This case presents surgery for glioma of the optic nerve (left eye) without enucleation of the eye, resulting in recession (enophthalmos) of the globe.  Vision was lost when the optic nerve was severed and the extensive surgery also caused unilateral loss of all ocular and appendage function.  Beside the immobility of the levator and rectus muscles, the receded globe caused blepharoptosis (total lid droop).

Figure 10A The surgery induced enophthalmos resulted in upper eyelid ptosis, depression of orbital fat under the eyebrow and loss of the upper tarsal lid fold.

Figure 10B Elevation of the upper eyelid shows a hypo-positioned eye.  This is highlighted by the catoptric image (light reflection on the cornea).

Figure 10C Replacement of orbital volume with a full thickness scleral ocular prosthesis over the blind eye eliminated enophthalmos, however, there was still the presence of a ptosis and only a slight upper tarsal lid fold.

Figure 10D Corrective adjustment for upper eyelid cosmesis was accomplished by extending the upper periphery of the prosthesis deeper into the upper fornix.  This elevated the lid to a near normal aperture resulting with an improved upper tarsal lid fold.

Figure 10E This combined photograph shows profile (upper) of the prosthesis with a normal anterior curvature.  The (lower) photograph shows the adjustment to the prosthesis in clear acrylic.  Note the deviation of the anterior curvature to support and elevate the upper lid.  Also, the thicker anterior posterior portion along the upper peripheral edge that restored the upper tarsal lid fold.