Year : 1980 | Volume
: 28 | Issue : 3 | Page : 117--120
Contracted sockets -I (Aetiology and types)
Eye Clinic, Marris Road, Aligarh, India
Eye Clinic, Marris Road, Aligarh
|How to cite this article:|
Krishna G. Contracted sockets -I (Aetiology and types).Indian J Ophthalmol 1980;28:117-120
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Krishna G. Contracted sockets -I (Aetiology and types). Indian J Ophthalmol [serial online] 1980 [cited 2020 Nov 27 ];28:117-120
Available from: https://www.ijo.in/text.asp?1980/28/3/117/28239
The contracted sockets has been a problem to ophthalmologists since the middle of the last century, when the operation of enucleation replaced the former operation of abscission of the eye. All the sockets exhibit a proclamity to contract and this is often quite marked. Various theories regarding the causation of the contraction of the socket were the microphthalmos, irradiation of the socket as after enucleation in some cases of retinoblastoma,, severe socket infections, faulty or non wearing of the artificial eye,,, keloid like mass formation in the socket, tissue loss due to injury, and scarring of the conjunctiva due to various factors,,,,
The present study was planned to consider the various factors involved in causation of socket contraction and to classify the socket contraction according to the morphology of the socket.
MATERIALS AND METHODS
The cases of the contracted sockets were examined clinically and microbiologically. In every case, mode, circumstances and duration of the eye loss, and subsequent problems with the prostheses were recorded. The socket was examined for fibrous bands, condition of the various fornices and the state of the conjunctiva.
The soft tissue sockets were divided into five grades for the sake of convenience in management of contracted sockets.
Grade-0: Socket is lined with the healthy conjunctiva and has deep and well formed fornices.
Grade-I: Socket is characterized by the shallow lower fornix or shelving of the lower fornix. Here the lower fornix is converted into a downwards sloping shelf which pushes the lower lid down and out, preventing retention of a artificial eye [Figure 1].
Grade-II: Socket is characterized by the loss of the upper and lower fornices, [Figure 2].
Grade- III: Socket is characterized by the loss of the upper, lower, medial and lateral fornices [Figure 3].
Grade-IV: Socket is characterized by the loss of all the fornices, and reduction of palpebral aperture in horizontal and vertical dimensions [Figure 4].
Grade-V: In some cases, there is recurrence of contraction of the socket after repeated trial of reconstruction [Figure 5].
52 cases of contracted sockets were studied. Their clinical observations were as under : - The age of the patients varied from 8 years to 58 years, affecting 38 males and 14 females. In 40 patients left eye was involved while in 12 the right eye was affected.
The main presenting complaint was story of a gradually increasing difficulty in retaining the prostheses. In 14 cases the patients were not satisfied with the cosmetic appearance.
Considering the cause of the eye loss, the commonest was trauma (17 perforating and 9 chemical), panophthalmitis (11 cases), endophthalmitis (10 cases), retinoblastoma (4 cases), and microphthalmos (1 case).
The duration between the eye loss and the time lapsed when the patient reported for treatment varied from 4 months to 37 years.
To exclude the bony pathology, X-ray examinations were carried out in 22 cases. All the cases showed similar dimensions in both the orbits.
All the 52 cases were studied for microorganisms, 9 in the lot were sterile and 43 were infected [Table 1].
Faulty artificial eyes were present in the socket in the form of either large artificial eyes (5 cases) or cracked or rough artificial eyes (9 cases).
Grade-wise maximum number of cases were reported in Grade-I (21 cases), then in Grade-II (12 cases), Grade-III (10 cases), Grade-IV (7 cases) and least in Grade-V (2 cases).
The main causes in Grade-I contracted sockets were physical injuries, endophthalmitis and retinoblastoma. In group-II, the main causes were physical injuries, endophthalmitis, panophthalmitis and retinoblastomas. In grade-III & IV, the main causes were chemical injuries and panophthalmitis and in grade-V, in this series, the main cause was the chemical injuries [Table 2].
There is no direct relationship between the age and sex and the amount of contraction of the socket. The involvement of the left eye was more than right eye for reasons unknown.
The interval between the loss of the eye and the time when the patient first reported for treatment was immaterial as after a certain period, contraction becomes stationary. No direct relationship between the amount of contraction and its duration could be established.
The organisms isolated from the socket do not appear to have any direct relationship with the socket contraction.
Sometime contact allergy to methylmetha acrylate of the artificial eye occurs and gives rise to chronic inflammation of the orbital tissues leading to socket contraction. This type of picture was present in 3 cases. If the artificial eye is too large, obstruction or displacement of the canaliculi may result, with consequent epiphora and ultimately chronic conjunctivitis results. This conjunctivitis may lead to orbital cellulitis and after some time lead to contracted socket. This type of picture was present in 5 cases.
Irrespective of other factors, the maximum contraction was seen in chemical injuries. then in panophthalmitis, physical injuries, endophthalmitis, retinoblastoma and least in microphthalmos.
In grade-I & 11 contracted sockets, shallow fornices \A ere due to orbital fat prolapse after the injury to the orbital septum during enucleation. In some cases fornices were shallow due to sub-mucous fibrosis after chronic inflammation of the sub-conjunctival tissues. In grade-III contracted sockets, all the fornices were obliterated due to the submucous fibrosis due to severe chronic inflammation of the tissues as in cases of panophthalmitis. In grade-IV contracted socket, all the fornices and palpebral aperture were narrowed due to the conjunctival shrinkage and fibrosis due to the chemical burn of the conjunctiva. In grade-V contracted sockets, recurrence of contraction of socket after reconstruction, were due to massive fibrosis post operatively in the socket tissues.
Our study concludes that there was no direct relationship between the socket contraction and duration of the eye loss. The extent of contraction of socket was found in descending order in cases of chemical injuries, panophthalmitis, perforated injuries, endophthalmitis, retinoblastoma and least in microphthalmos.
In this study, 52 cases of contracted sockets were evaluated from the point of aetiopathogenesis and classified into five grades.
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