A 47-year-old gentleman complained of an ill fitting prosthesis with frequent loss of the prosthesis from the eye socket. On clinical examination, the medial caruncular portion of the prosthesis was elevated from the conjunctival surface []. The inferior fornix was shelved and the implant was palpable anterior to the inferior orbital rim with inferotemporal migration []. Volume loss was evident in terms of SSD and enophthalmos. CT scan of the orbit showed an 18-mm orbital implant, migrated into the extraconal space in the inferotemporal quadrant []. He had undergone two socket surgeries in the past including an enucleation with implant for a painful blind eye followed by fornix formation sutures for a shallow inferior fornix. Based on the above findings, a diagnosis of inferotemporal implant migration was made and a PSI was fabricated as described above. This was placed in the basin of the inferior orbital fissure to recenter the migrated orbital implant. The surgical steps were as discussed in methods. A customized ocular prosthesis (COP) remained stable and central thereafter over his follow-up of 2 years. He underwent a ptosis surgery for mild anophthalmic ptosis after 18 months []. The spherical orbital implant was maintained in the central position over his entire follow-up period []. Hertel's exophthalmometry on both sides was equal. Postoperative CT scan of the orbit showed the PSI in place with intraconal recentration of the spherical implant []. There was no reduction in prosthesis motility.
A 43-year-old lady presented to us with complaints of frequent fall of the prosthetic eye from the left eye socket since the past 4 years. She had undergone an evisceration for panophthalmitis followed by secondary implant for volume augmentation 10 years ago. On examination, she had a sunken appearance of the prosthesis with a grade IV SSD and a 4-mm enophthalmos on the left side. There was inferotemporal implant migration with a shallow fornix. She underwent a PSI placement that helped center the migrated spherical implant. The fornix deepened after PSI placement. However, the SSD persisted for which she had a filler injection. Over a follow-up period of 15 months there were no complications noted with either implants. The fornix remained deep thereafter.