The right prosthetic eye fails to improve the lost orbital volume and bears down on the lower eyelid. The scleral colour has been ‘overdone’ in an attempt to reduce the impact of the large size. This is a case where volume replacement surgery is needed.
There are two approaches to replacing lost orbital volume. The first is to provide a larger implant where the existing one is inadequate and the second is to place a sub-periosteal implant on the boney floor of the orbit. The surgeon makes an incision along the inferior fornix inside the socket and then lifts the periosteum from the orbital floor to create a pocket. A preformed silicon or porous polyethylene sled implant is trimmed to size and placed in the pocket. This displaces the orbital tissues upwards and forwards restoring the lost volume and filling out the deep upper eyelid sulcus.