Repair of hydroxyapatite orbital implant exposure with a conjunctival Muller muscle flap

Exposure is the most frequent complication with hydroxyapatite orbital implants. We recommend three different surgical approaches to repair exposure of hydroxyapatite implants with a conjunctiva-Muller muscle pedicled flap. In the first technique, this conjunctiva-Muller muscle flap is cut at the superior edge of the tarsal plate. In the second technique, it is divided at the origin of the levator aponeurosis. In the third technique, part of the superior tarsus is included with the Muller muscle in the flap. A second surgical procedure is necessary to divide the pedicle. This is a recent approach to treating orbital implant exposure, the vascularized tissue improving fibrovascular ingrowth.