A surgical technique for the successful and stable reconstruction of the totally contracted ocular socket

We describe the successful and stable reconstruction of 47 severely contracted sockets over a 10-year period. The surgical technique employed in all these cases used a large custom-designed, C-shaped conformer wrapped with a full-thickness oral mucous membrane graft. After all cicatricial tissue within the socket was excised, the wrapped conformer was sutured at its midperiphery to the inferior and superior orbital rims. In contrast to other procedures using flatter conformers, which direct their force in a vertical dimension, this uniquely designed conformer directs its force both vertically and deeply posteriorly within the socket. A somewhat modified but similar conformer also can be used for sockets compromised by total symblepharon formation. Excluding six patients with inadequate follow-up, we were able to successfully reform spacious and stable fornices in 40 of 41 severely contracted sockets. The average postoperative follow-up after reconstruction in these cases was 23.9 months. This technique represents an effective approach to successfully reconstruct and maintain stable ocular cul-de-sacs in cases of severe socket contracture or total symblepharon formation.