Superior conjunctivoplasty-mullerectomy for correction of chronic discharge and concurrent ptosis in the anophthalmic socket with enlarged superior fornix.

PURPOSE: Many anophthlamic patients with ocular prostheses experience chronic discharge. A subset of these patients is found to have concurrent ptosis and an enlarged superior conjunctival fornix. Examination reveals an enlarged superior fornix with copious mucopurulent discharge. The subset of patients meeting these criteria is very small, and estimated incidence cannot be determined. The authors propose that using a modification of the conjunctivomullerectomy to decrease the potential space in the enlarged fornix while at the same time correcting the ptosis will help alleviate this chronic discharge.

METHODS: A retrospective review of 5 anophthalmic patients who underwent a modified superior conjunctivoplasty- mullerectomy was performed. All patients had chronic discharge and an enlarged superior conjunctival fornix, with mucous collection noted in the cul-de-sac. All patients had a concomitant ptosis and superior sulcus deformity on the affected side. Postoperative outcomes regarding correction of discharge, ptosis, and enlarged superior fornix were obtained.

RESULTS: All patients had improvement in their chronic discharge. Palpebral fissure measurements improved from a median of 6.5 mm (range 6-8 mm) at baseline to 9.25 mm (range 8-10 mm) at last follow-up. The enlarged superior fornix was corrected in all patients.

CONCLUSIONS: A modified superior conjunctivoplasty- mullerectomy is an effective method for correcting chronic discharge and ptosis in anophthalmic patients who have an enlarged superior conjunctival fornix.