Management of Implant Exposure and Extrusion

Despite advances in orbital implant design and refinements in technique, exposure and extrusion remain both relatively common and challenging to manage. The increased popularity of porous implants confers a number of significant advantages, which are in turn counterbalanced by well-characterized and distinctive drawbacks when compared to solid spheres. A thorough understanding of implant sizing and material properties, wrapping options, and surgical technique is critical to minimizing the incidence of exposure. When it does arise, rescue techniques with patch grafts or vascularized flaps are used in conjunction with removal of any clearly avascular portion of the implant. Should implant removal be required, thoughtful management of conjunctival and forniceal deficits is essential to permit successful future prosthesis wear.