Surgery for vertical orbital dystopia always includes augmentation of the orbital floor. Most of the time the inferior orbital rim is lower as well and needs to be concurrently augmented. Various materials have been used for orbital implants from bone grafts to numerous synthetic implants. In the ‘aesthetic’ orbital dystopia patient (4mms or less of horizontal pupillary discrepancy) the use of bone grafts is not very appealing.
The ideal method to augment the orbital floor and lower rim is to make custom implants from a 3D CT scan of the orbits. With this technology the exact amount and location of orbital floor and rim augmentation can be determined and made before surgery. This obviates any need for intraoperative fabrication of the implants.
Beyond the use of preoperatively fabricated implants, various materials offer intraoperative workability. One of my favorite implant materials for the orbit is that of ePTFE. Originally known as Goretex, it comes in sheets of various thicknesses that are easily cut and molded to any surface. Composed of a fluorine-based material that is both very smooth and non-reactive, its flexibility and adaptability make it ideal for the complex contours of the orbit.
ePTFE sheets of 2mm thickness can be layered and adapted to the orbital floor and inferior orbital rim as needed. It is a good idea to secure the material to the orbital rim with several micro screws to make sure it lays flat and is as non-palpable as possible through the thin tissues of the lower eyelid.
Dr. Barry Eppley