Simultaneous Reconstruction of Early Orbital Implant Exposure and Lower Eyelid Symblepharon Using an Oral Mucosal Membrane Graft Following Evisceration

A 72-year-old male patient presented with early orbital implant exposure and lower eyelid symblepharon after evisceration surgery performed at an outside center after severe ocular penetrating trauma. A single-stage reconstruction was performed. After release of the lower eyelid symblepharon and exposure of the remaining scleral tissue, previous closure with 6-0 polypropylene sutures and the absence of well-defined scleral flaps were noted. The nonabsorbable sutures were removed, 2 scleral flaps were fashioned, and the same 20-mm silicone orbital implant was reinserted because no clinical signs of active socket infection were observed intraoperatively. The scleral flaps were closed with 6-0 polyglactin sutures, followed by Tenon's capsule and conjunctival closure. The inferior fornix was reconstructed using an oral mucosal graft harvested from the lower lip, with transcutaneous fixation sutures, external bolster support, and scleral conformer placement. At 8 weeks, the graft was well integrated, the implant remained stable, and successful ocular prosthesis fitting was achieved. To the best of our knowledge, this combined single-stage approach has not previously been described in the indexed literature.