Correction of a lower eyelid deformity caused by multiple extrusions of alloplastic orbital floor implants

The case of a young woman is presented in whom a silicone orbital floor implant became extruded into the maxillary sinus 8 years after its insertion for an orbital floor fracture. Two subsequent attempts at correction using silicone only compounded the problem. Ultimate correction, in two stages, required (1) an iliac bone graft to the infraorbital rim and orbital floor defects, along with a temporal muscle flap and nasal antrostomy; and (2) an upper lateral cartilage chondromucosal graft and a full-thickness postauricular skin graft. A warning is sounded against the use of alloplastic materials for major orbital floor defects, particularly when there have been problems with these materials.