Two surgical procedures for inserting secondary implants are described. The objective of both is correction of the enophthalmos and deep superior lid sulcus which frequently follow enucleations in which no intraorbital implant is used or the implant extrudes.
In the first technique, a secondary implant is placed posterior to Tenon's capsule. The surgical approach is through central conjunctiva and Tenon's capsule. A simple plastic or silicone sphere, or a silicone sphere with Dacron velour bonded to its anterior surface may be used. The second technique utilizes placement of an expandable evisceration implant through a lateral brow incision. Since the approach avoids incising Tenon's capsule and conjunctiva, it is felt there is less chance of a repeated extrusion.
Soll DB. Insertion of Secondary Intraorbital Implants. Arch Ophthalmol. 1973;89(3):214-216. doi:10.1001/archopht.1973.01000040216011