Enucleation

A 63-year-old man's left eye was enucleated after it was severely injured in an automobile accident several years earlier. He chose not to have an artificial eye for his left socket. Thus, pseudoptosis developed, and the socket appeared sunken (Figure 1A). The socket tissue was otherwise healthy and intact (Figure 1B).

Pseudoptosis can result from insufficient posterior support of the eyelid, which occurs with enucleation, microphthalmos, anophthalmos, and phthisis bulbi. Phthisis bulbi--a shrinking, wasting, and atrophy of the eyeball, as seen in another patient (Figure 2)-may be a sequela of panophthalmitis, absolute glaucoma, or other conditions.

Often, pseudoptosis can be relieved by the fitting of a prosthesis. Ptosis that persists after the prosthesis is placed may be treated by a small levator resection or by an internal transconjunctival Mller's muscle resection to tighten and lift the lid.

The patient was encouraged to consult an ocularist. He was fitted with an artificial eye (Figure 1C) and has been quite satisfied with it.