The adequacy of ocular reconstruction following enucleation or evisceration of the globe can be evaluated based on findings from the clinical examination.
Measures:
(1) superior sulcus deformity
(2) relative enophthalmos (backward displacement of the prosthesis)
NOTE: I was not able to find a definition for the superior sulcus deformity in standard textbooks. Based on usage it appears to be a noticeable gap between the superior edge of the prosthesis and the upper eyelid (or superior edge of the orbital cavity).
Superior Sulcus Deformity
Grade
none
0
trace, medial only, barely visible
1
mild, medial only, easily visible
2
moderate, medial and central
3
severe, extending medial to lateral
4
Relative enophthalmos is measured using a Hertel exophthalmometer.
A successful outcome is defined as both:
(1) superior sulcus deformity Grade 0
(2) relative enophthalmos absent or < 2 mm
Conditions associated with increased likelihood of a cosmetic defect after reconstruction:
(1) infection
(2) radiation therapy
(3) buphthalmos
(4) large orbital fractures
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