Reconstruction of the anophthalmic socket: state of the art.

A successfully rehabilitated anophthalmic socket must hold and support a prosthetic device that mimics the contralateral globe. The goal is symmetry. Static symmetry of the palpebral apertures, canthal angles, and superior sulci are basic objectives. Full versions of the socket implant and prosthesis and full upper lid excursion are definitely desirable but difficult to attain. Adequate lid levels and contours and sufficiently deep conjunctival fornices are necessary to keep the prosthesis in place. Buccal mucous membrane and composite dermis-fat grafts as well as vascular pedical flaps can be used to expand contracted sockets. Canthal tendon shortening and fixation can be effectively used to reestablish lid and canthal contours and to support the prosthesis.