Inadequate inferior cul-de-sac in the anophthalmic socket

A retrospective review of preoperative findings and postoperative results of conjunctival cul-de-sac fixation surgery performed on 12 patients with acquired anophthalmos and an inadequate inferior conjunctival cul-de-sac was performed. Patients with inadequate conjunctiva or other subconjunctival cicatricial shortening of the inferior cul-de-sac were not suitable candidates for conjunctival cul-de-sac fixation surgery and therefore were excluded from this retrospective study. Only those patients with adequate conjunctiva and loss of inferior cul-de-sac fixation to the lower eyelid retractor complex were selected. Clinical evaluation and theoretical anatomical analysis of this group preoperatively suggested that the absent inferior conjunctival cul-de-sac fixation could allow the intraconal orbital fat to migrate anteriorly, compromising the inferior fornix and prolapsing the conjunctiva of the cul-de-sac superiorly. Surgical correction required direct fixation of the conjunctival cul-de-sac to the periosteum immediately posterior to the inferior orbital rim. No externalized sutures or stents were needed to recreate the inferior conjunctival cul-de-sac. All 12 patients had improved ability to retain a prosthetic eye postoperatively. However, two patients had minimal postoperative lower eyelid retraction and an additional two patients had minimal lower eyelid entropion after surgery. Secondary surgery was not required in any patient.