[Alcohol Injection in a Patient with Chronic Orbital Pain after Enucleation - a Case Report and Review of the Literature]. / Alkoholinjektion bei chronischem orbitalem Schmerz nach Enukleation ­ Falldarstellung und Literaturübersicht.

A case is presented of a 54-year old patient who had been treated 10 months previously with enucleation for a painful blind eye. This led to severe and chronic pain in the orbital region that did not respond to conventional pain management. However, a single 1.5 ml injection of 96 % ethanol led to almost complete resolution of pain for the follow-up period of 6 months. Orbital pain after enucleation or evisceration may originate from the implant itself, the prosthesis, the socket or the sinuses. Taking a careful medical history and an examination, including orbital scans, are necessary to decide on the correct differential diagnosis. If any pathology is excluded, one should keep in mind that phantom pain in the orbit seems common after removing an eye, more often when pain originating from the ball and/or headache was present before removal. The management of chronic pain in the orbital region has received little attention. Retrobulbar alcohol injection still has a place in modern ophthalmology, because it delivers effective pain relief in certain chronic conditions.

[Development of oculoplastic surgery in Kinshasa (capital of Democratic Republic of Congo)]. / Entwicklung der okuloplastischen Chirurgie in Kinshasa (Hauptstadt der Demokratischen Republik Kongo).

The partnership between Saint Joseph Hospital in Kinshasa (Capital city of DRC) and University Eye Clinic Rostock, Germany exists since 2000. The ophthalmologists from Rostock University performed 12 visits of St. Josef Hospital with the aim to perform oculoplastic surgery in complicated cases as well as to teach the local ophthalmologists. There they performed about 150 surgeries (entropion, ectropion, ptosis, repair of lid injuries, eye lid reconstruction and tumour management, lacrimal surgery) in joint teams. The programme of on-site training was established during this time. Meanwhile, the Kinshasa colleagues are able to perform the basic techniques by themselves. Two colleagues have obtained advanced training in oculoplastics in Rostock. The fruitful cooperation enabled the development of oculoplastic surgery in St. Josef Hospital in Kinshasa. The further education and training proccesses will support the continuous advancement in ophthalmological health care in DRC.

[Faden operations - indications beyond esotropia and surgical results]. / Fadenoperationen außerhalb des Innenschielens - Indikationen und operative Ergebnisse.

BACKGROUND: Faden operations is a well-known surgical option for the treatment of esotropia. To the best of our knowledge there are only a few reports available dealing with this particular topic. PATIENTS AND METHOD: Retrospective series of patients in whom between 2000 and 2011 a faden operation was performed under all indications except esotropia. 23 patients (9 Graves' disease, 9 third nerve palsy, 3 sixth nerve palsy, 1 muscle dystrophy, 2 orbital trauma) were included. RESULTS: 5 out of 7 horizontally disturbed patients were operated unilaterally and the remaining 2 bilaterally. The field of binocular single vision increased from 15-70° preoperatively by 10-25° (unilateral) and 20-35° (bilateral) to 30-80° postoperatively. Out of the 16 vertically disturbed patients only one was operated on superior and inferior rectus simultaneously and all the other on only one muscle. The field of binocular single vision increased from 5-55° preoperatively by 5-45° to 10-80° postoperatively. There were no complications so far and none of the patients worsened with the surgery. CONCLUSION: A faden operation might help to increase the field of binocular single vision in cases of restrictive squint like Graves' disease or in paralytic strabismus.

[Ophthalmological findings in paediatric and adolescent multiple sclerosis]. / Augenärztliche Aspekte Multipler Sklerose im Kindes- und Jugendalter.

BACKGROUND: Multiple sclerosis (MS) is a chronic demyelinating disorder of the central nervous system of unknown aetiology. The onset of MS in childhood poses diagnostic and therapeutic challenges. Differential diagnoses include acute disseminated encephalomyelitis and neurometabolic leukoencephalopathies. In this article the ophthalmological findings of paediatric and adolescent MS patients are described and discussed in the light of earlier studies. METHODS: In a retrospective study we evaluated the ophthalmological and neuro-ophthalmological findings of 44 paediatric/adolescent MS patients (aged 8-18 years). RESULTS: In 18/44 patients optic neuritis was found. Abnormalities of ocular motility were seen in 9/44 patients, 5/44 had abduction limitation, 3/44 internuclear ophthalmoplegia and 1/44 horizontal gaze palsy. Furthermore, 13/44 children showed nystagmus, mostly gaze-induced nystagmus. Uveitis was present in 4/44 patients. CONCLUSIONS: The ophthalmological and neuroophthalmological findings may lead to the diagnosis of MS. Children presenting with these symptoms should be examined by a paediatric neurologist.

[Hydrogelexpander as drug delivery system for antibiotics]. / Hydrogelexpander als Medikamentenabgabe-System für Antibiotika.

PURPOSE: The suitability of a high-hydrophilic osmotic self-inflating hydrogel expander consisting of a co-polymer of N-vinylpyrolidone and methyl methacrylate as a drug delivery system for antibiotics to prevent a postoperative infection was investigated in a laboratory setting. METHODS: The dry expanders were incubated in a 0.3 % solution of Ofloxacin or Tobramycin for 24 hours. The completely swollen expander had increased in volume from 0.3 mL to almost 3 mL (adsorbing 2.7 mL of the 0.3 % solution, i. e.,8.1 mg of Ofloxacin or Tobramycin, respectively). Addressing the elimination of both antibiotics, the concentrations in 15 mL elution medium (simulating the volume of the orbit in a newborn baby) were measured after 0.25, 1, 2, 6, 24, 48 and 72 hours of elution. 0.9 % sodium chloride (B. Braun Melsungen, Germany) was used as elution medium. To imitate fluid exchange due to blood perfusion in the surrounding tissue the medium was renewed after every sampling. For each substance 10 expanders were tested. Concentrations of antibiotic were determined by HPLC/UV for Ofloxacin and by using a specific fluorescence-polarisation immunoassay (Abbott TDx) for Tobramycin. RESULTS: Mean concentrations of Ofloxacin at 0.25, 1, 2, 6, 24, 48 and 72 hours after beginning of the elution were 50.2, 46.8, 41.2, 75.4, 88.2, 46.2 and 19.1 µg/mL, respectively. The cumulative amount of Ofloxacin eluted after 72 hours reached 68 % of the loading dose. The corresponding mean concentrations of Tobramycin were 38.8, 48.5, 40.5, 69.8, 88.7, 119.3 and 71.6 µg/mL. The cumulative eluted amount was 88 %. CONCLUSIONS: The investigated hydrogel expanders soaked in 0.3 % antibiotic solution can store and later on release sufficient amounts of Ofloxacin or Tobramycin to produce antimicrobial effective concentrations in vitro in the surrounding environment. This principle, when used in a clinical setting, might help to eliminate post-implantation infection which is one of the major complications in clinical use.

In vitro kinetics of delivery of tobramycin and ofloxacin from osmotic hydro gel expanders.

OBJECTIVE: High-hydrophilic osmotic self-inflating hydro gel expanders are well-accepted for implantation to achieve tissue expansion in defined parts of the body like skin, breast and orbital soft tissue. To prevent post-implantation infections effective antibiotic prophylaxis might be helpful. The suitability of this hydro gel consisting of a co-polymer of N-vinyl-pyrolidone and methyl-methacrylate as a drug delivery system for antibiotics was investigated in a laboratory setting simulating the orbit in a newborn. METHODS: In a first setting the dry expanders were incubated in a 0.3% solution (5 ml) of tobramycin and ofloxacin for 24 h (n = 10 for each substance, adsorbing 2.4 ml of the 0.3% solution, i.e. 7,200 µg antibiotic). Addressing the release of both antibiotics, the concentrations in 15 ml elution medium (0.9% sodium chloride, renewed after every sampling) were measured after 0.25, 1, 2, 6, 24, 48 and 72 h of elution. To simulate the clinical use in a second setting the expanders were dried after incubation in a 0.3% and 0.03% solution of tobramycin (n = 5 for each concentration) before measuring the release. RESULTS: The cumulative amount of tobramycin released after 72 h reached 7,157 µg, i.e. 99% of the initially loaded antibiotic. The cumulatively released amount of ofloxacin was 5,505 µg (76% of loading dose). Main fraction of release (about two thirds) was detected for both antibiotics for a elution period 0 - 24 h. In the periods 24 - 48 and 48 - 72 h the released amount of tobramycin was significantly higher than for ofloxacin. The release from expander dried after loading tobramycin was comparable: The cumulatively released amount of 0.3% and 0.03% incubation solution was 99% and 79% of loading dose, respectively. CONCLUSIONS: The investigated hydro gel expanders soaked in antibiotic solution can store and further on release sufficient amounts of tobramycin or ofloxacin to produce antimicrobial effective concentrations in vitro in the surrounding environment according to the breakpoints reported by EUCAST [14]. This principle, when used in a clinical setting, might help to eliminate post-implantation infection, which is one of the major complications in clinical use.

[Graves' orbitopaty: inferior rectus tendon elongation for large vertical squint angles that cannot be corrected by simple muscle recession]. / Endokrine Orbitopathie: M.-rectus-inferior-Sehnenverlängerung bei großen vertikalen Schielwinkeln, die nicht durch eine einfache Muskelrücklagerung korrigiert werden können.

BACKGROUND: In motility disorders related to Graves' orbitopathy, recession of fibrotic eye muscles is the treatment of choice. Correction of very large squint angles can be difficult, since the distance of recession is limited by the necessity to maintain a sufficient arc of contact. A new technique of tendon elongation has been developed in order to maintain sufficient arcs of contact even in patients with large horizontal squint angles, especially after orbital decompression surgery. The established dose-effect relationship cannot simply be conveyed to inferior rectus muscle surgery, due to a different impact of simple recession on inferior and medial rectus muscles. METHODS: Recession of the inferior rectus muscle was performed in 10 patients with simultaneous suturing of bovine pericardium (Tutopatch). This procedure was performed as primary surgery in 7 patients (2 after orbital decompression) and as secondary procedure in 3 patients. Squint angle (far distance), bulbus excursion movements and field of binocular single vision were evaluated pre- and postoperatively. RESULTS: Alignment (far distance) was achieved in 8 of 10 cases at the final follow-up examination. Two patients required corrective prisms. Visual fields were virtually free of diplopia in all patients. The dose-response effect for tendon elongation of the inferior rectus muscle was identical to that for the simple recession of this muscle. There were no complications. CONCLUSIONS: The new technique of tendon elongation using a bovine pericardium graft is applicable in large vertical squint angles (with or without prior bony orbital decompression) as well as for corrections after insufficient simple recessions (by realignment of the muscle and secondary suturing of the graft). Functional improvement can thus be achieved through surgery of a single muscle, keeping the other muscles in reserve for further interventions (lowering the risk of postoperative anterior segment ischaemia). There is a dose effect analogous to large horizontal squint angles in Graves' orbitopathy (dosing formula: 1 mm inferior rectus recession [including graft] leads to 2.0° vertical angle reduction). This corresponds to simple recessions of the inferior rectus muscle but differs from tendon elongations of the medial rectus muscles.

[Amyloidosis--a rare differential diagnosis of an orbital tumour]. / Amyloidose--ein seltene Differenzialdiagnose orbitaler Raumforderungen.

BACKGROUND: Amyloidosis is a disorder caused by a misfoulding of proteins. The deposition of these proteins in tissues and organs can affect the normal function of those tissues and organs. MATERIALS AND METHODS: Two patients are presented and an overview over the so far published cases with a localised orbital amyloidosis is given. RESULTS: The first case is a 50-year-old woman with progressive ptosis since half a year, progressive proptosis since three months and deterioration of motility and deviation of the left globe. The second case is a 68-year-old man with progressive ptosis since four years and with affection of the subtarsal conjunctiva of the right eye. Macroscopically a yellow-brown, gelatinous, easily crumbled material was seen during operation. CONCLUSION: the histological proof of amyloidosis can be made visually in intense unidirectional polarised light after congo red staining. This should be done in suspected cases every time. The orbita can also be involved in systemic forms of amyloidosis, so a systemic form should be excluded. The localised amyloidosis has no effect on the survival time in contrast to the systemic forms does have an effect. An untreated systemic form may be associuated with a prognosis of only 9 to 13 months.

[Comparing specific disc findings of a European and a Bantu population]. / Vergleich papillenspezifischer Parameter einer europäischen und einer Bantu-Population.

BACKGROUND: Glaucoma is the main cause of irreversible blindness in the world. Because of the increasing mean age, glaucoma is expected to become more common in the developing countries. Besides tonometry and perimetry the appearance of the optic nerve head is a main part of glaucoma diagnosis. Ethnic differences have to be considered. This study compares the appearance of the optic nerve head between blacks and whites. STUDY DESIGN: This is a retrospective analysis of 225 whites of a Swiss population and 1027 blacks of a Congolese population. Using a matched pairs technique 207 whites and 207 blacks were chosen, regarding age, sex, intraocular pressure and examined eye (right/left). The analysis of the optic nerve head was performed by using the "Heidelberg-Retina-Tomograph II" (HRT). RESULTS: Among the 207 persons of both groups we found 116 females and 91 males. There were 103 right eyes and 104 left eyes examined. The mean age was 45.6 +/- 15.6 years. Compared with European population in the African population we found a greater disc area (2.56 vs. 1.81 mm(2)) as well as a greater cup area (0.65 vs. 0.41 mm(2)) and a greater rim area (1.91 vs. 1.40 mm(2)). Regarding the cup disc area ratio there was no significant difference between both populations found (Kinshasa: 0.24 vs. Basel: 0.21). Although there was no significant difference of the maximum cup depth of both groups we found a deeper mean cup depth in the African population. Furthermore, we found differences regarding the cup shape measure, the RNFL thickness and the height variation contour. CONCLUSION: As already described in different studies, there are significant differences in the morphology of the optic nerve head between blacks and whites. Although blacks are expected to have a greater cup disc area ratio, this fact could not be proved in this study. As a new fact we found a different mean cup depth between Africans and Europeans, which might be explained by the different cup shape of both populations.

[Autogenous tarsus transplant as spacer for treatment of lower lid retraction in Grave's disease]. / Das freie autologe Tarsustransplantat als Spacer zur Behandlung der Unterlidretraktion bei Endokriner Orbitopathie.

BACKGROUND: Lower lid retraction in dysthyroid orbitopathy is of less functional concern than optic neuropathy or diplopia in central positions of gaze. However, it may lead to incomplete lid closure resulting in corneal exposure. Patients often suffer from aesthetic impairment. PATIENTS AND METHODS: A retrospective analysis of 13 consecutive patients treated for lower lid retraction due to Grave's Disease between 2005 and 2007 was undertaken. In spite of regular ophthalmological examinations, specific attention was directed to measurement of the lid fissure width and scleral show for quantification of lower lid retraction. OPERATION: The lower lid is everted and the conjunctiva is opened horizontally underneath the tarsal edge. Lower lid retractors are disinserted and dissected until the lower lid might be elevated in symmetry to the fellow eye. This procedure is continued until 1 mm overcorrection is gained. A free tarsal transplant is harvested from the ipsilateral upper lid tarsus. At least 4 mm vertical tarsus have to be left. Tarsus is sutured with absorbable material. RESULTS: In the 13 patients operated upon (9 women, 4 men) aged 23 - 67 years, scleral show was preoperative 2.7 mm (mean) and postoperative 0.1 mm. Lid fissure width was preoperative 13 mm (10 - 16 mm) and immediately postoperative 10.3 mm (7 - 13). 6 months postoperative the lid-elevating effect was reduced by 0.5 mm in maximum in the 9 patients available for control. The lid closure deficit, which was present in 7 patients before, could be corrected completely in 5 and diminished to 1 mm in 2 patients. CONCLUSIONS: Using this particular technique, functional and aesthetical satisfying results are obtained. The main advantages are renunciation of allogen, xenogeny or synthetic material with its possible risks of slow-virus infection and/or extrusion. Further studies are necessary to evaluate long-term results.

[Management of anticoagulants in ophthalmic surgery-a survey among ophthalmic surgeons in Germany]. / Umgang mit gerinnungshemmenden Substanzen in der Ophthalmochirurgie ­ eine Umfrage unter Ophthalmochirurgen in Deutschland.

INTRODUCTION: As our population ages and comorbidities rise, ophthalmic surgeons are increasingly faced with patients on anticoagulant therapy or with clotting disorders. The ophthalmic surgeon has to weigh the perioperative risk of haemorrhage when anticoagulation continues against the risk of thromboembolism caused by discontinuation or changing the patient's medication (bridging, switching, cessation). There are currently no guidelines or recommendations. METHODS: A survey was sent to the DOG (German Ophthalmologic Society) divisions and associated surgical organizations to determine the status quo. A questionnaire was sent out and filled out by the different groups of specialists. RESULTS: All four divisions of the DOG and four associated organizations returned completed questionnaires. Surgical interventions were listed that are carried out during anticoagulant therapy without exceptions, as well as interventions that were classified to require medical adjustment. Although the assessments varied, general consensus was achieved regarding interventions not requiring adjustments due to anticoagulants (i. e., intravitreal injection, cataract surgery, laser and corneal operations, simple muscle surgery), and those interventions requiring adjustments in medications (glaucoma operations, complex retina surgery, eye socket surgery, complex surgery of the lid). CONCLUSION: Main result of this survey was the specification of serious bleeding complications which are permanent vision loss and re-operation. They could serve as endpoint parameters for essential future investigations. Nevertheless, this survey makes clear that the decision about an adjustment of anticoagulant medication in ophthalmic surgery is currently made individually and not based on established standards.

[Childhood blindness. VISION 2020 and experiences in an African city]. / Kinderblindheit. VISION 2020 und Erfahrungen in einer afrikanischen Grossstadt.

The struggle against childhood blindness is being given high priority by the WHO. In regions of the world countries where the income per head is low there are 5 times as many blind children as in wealthy countries (1.5/1000 vs 0.3/1000 children). In developing countries cataract is regarded as the main cause of blindness in both childhood and adulthood. If all cataracts that would lead to blindness were operated on, despite a comparatively smaller number of affected persons a similar number of sighted life-years could be achieved throughout the world to that for patients with senile cataract. The partnership between the Rostock Ophthalmological Department and St. Joseph's Hospital in Kinshasa focuses on the analysis and treatment of avoidable blindness in children. Its main concern is the introduction of appropriate procedures for cataract surgery, in most cases combined with the implantation of injectable synthetic intraocular lenses. In the last 7 years about 600 procedures have been jointly performed, including 400 of congenital cataract, mostly bilateral.

Injectable self inflating hydrogel pellet expanders for the treatment of orbital volume deficiency in congenital microphthalmos: preliminary results with a new therapeutic approach.

BACKGROUND/AIM: Children with congenital microphthalmos are usually able to wear an eye prosthesis but the cosmetic aspect is determined by the size of the orbital volume deficiency. Instead of using a ball shaped standard hydrogel expander or a regular orbital implant, which would necessitate enucleation of the microphthalmic eye, this study investigates the feasibility of volume augmentation with injectable pellet expanders, as formerly suggested for acquired anophthalmos in adults only. METHOD: The pellet expander is made from a self inflating hydrogel that takes up water by osmosis (dry state: length 8 mm, diameter 2 mm, volume 0.025 ml; in vitro hydrated state after around 1 day: length 15 mm, diameter 4 mm, volume 0.24 ml; swelling capacity: 9.6-fold). This report concerns six patients (two girls and four boys) aged between 4 months and 42 months with unilateral microphthalmos who were treated by injection of 4-14 pellet expanders into the retrobulbar orbital tissue. Volume augmentation was 1-3.5 ml. The pellets were injected using a customised trocar and placed behind the microphthalmos directed into the intraconal space. RESULTS: The increasing orbital volume was noticeable within 2 days and was confirmed by ultrasonography and magnetic resonance imaging. The final result can be anticipated by the volume augmentation effect produced by the amount of saline solution injected in the orbital apex region. All patients were fitted with an artificial eye, which was subsequently enlarged every 3-5 months. Anophthalmic enophthalmos was fully compensated with this technique. No complications have been encountered to date. CONCLUSIONS: Orbital volume augmentation with injectable self inflating hydrogel expander pellets is apparently a safe, quick, and minimally invasive technique for various indications in orbital reconstructive surgery-for example, to treat an enophthalmic appearance in microphthalmos and congenital or acquired anophthalmos.

[Diseases of the lacrimal gland]. / Erkrankungen der Tränendrüse.

Experience with the differential diagnosis of lacrimal gland illnesses is limited in daily practice due to their rarity. It is therefore of particular importance to have guidelines for the practitioner by which he can decide on the application of conservative or surgical therapy, and whether it is necessary to take a biopsy to clarify the diagnosis. There is a wide spectrum of possible illnesses which include systemic diseases, inflammatory disorders, neoplastic, benign and malignant tumors. When a pleomorphic adenoma cannot be excluded, biopsy is contraindicated and complete tumor excision with its capsule is necessary to prevent the possibility of malignant transformation and a negative effect on long-term prognosis. In this overview, special interest is placed on the typical clinical aspects and imaging features of lesions of the lacrimal gland fossa, their differential diagnosis and management.

[Underestimated trivial injuries after a fall. Sometimes it is more serious]. / Unterschätzte Bagatellverletzungen nach Sturz. Es "steckt" manchmal mehr dahinter.

In ophthalmological emergencies, patients often present with injuries after falling on their face in particular involving the periocular region. Often these are only trivial injuries of the conjunctiva, eyelids or periocular skin, which require no further treatment. Small dehiscences can be treated with sutures, fibrin glue or Steri-Strips; however, sometimes injuries that are more serious can be mistaken as being trivial but only represent the tip of the iceberg of the actual injury and, therefore, further diagnostics and therapy are required.

[Lateral orbital decompression for Graves' orbitopathy. Indication, surgical technique, and treatment success]. / Laterale knöcherne Orbitadekompression bei endokriner Orbitopathie. Indikation, Operationstechnik, Behandlungserfolg.

PURPOSE: In Graves' disease a discrepancy between volume increase of the orbital soft tissues and fixed volume of the orbital cavity leads to exophthalmos. The patients do not only feel cosmetically disfigured, they often complain about more or less painful retroorbital pressure sensation or show symptoms of compressive optic neuropathy or corneal exposure because of a significant lid lag. To solve this problem, different orbital decompression techniques have been developed. This is to report about our results with a modified Dollinger technique for lateral orbital decompression. PATIENTS AND METHODS: A total of 27 patients aged 19-76 years (mean: 45.1 years) with Grave's ophthalmopathy were recorded who had undergone orbital decompression by a lateral approach between June 1999 and April 2003. The modified Dollinger technique was performed by deepening the osteotomy to the level of the sphenoid wing and by additional resection of intraconal fat. RESULTS: The reduction of exophthalmos achieved after decompressive surgery averaged 2.9 +/- 1.1 mm. Of the patients whose indication for orbital decompression was a compressive neuropathy, the visual acuity improved postoperatively for 3 lines. Of the 16 patients with preoperative retrobulbar pressure sensation, 12 had no complaints after the operation. Remarkably no significant impairment of the ocular motility resulted after surgery. CONCLUSIONS: Decompression of the orbit by the modified Dollinger technique is a safe and effective approach to reduce exophthalmos, retrobulbar pressure sensation, and compression neuropathy as a result of diffusely elevated orbital tissue tension. In the case of direct compression of the optic nerve in the orbital apex, additional medial orbital wall decompression has to be considered.

[Congenital clinical anophthalmia and blind microphthalmia]. / Kongenitaler klinischer Anophthalmus und funktionsloser Mikrophthalmus. Vergleichende Betrachtungen zu unterschiedlichen Therapiekonzepten.

Congenital anophthalmia and blind microphthalmia are very rare conditions and there is no standard treatment available. Various previously reported therapeutical concepts are reviewed. The clinical picture can be divided into three subgroups with different therapeutical options recommended: in microphthalmia the conjunctival sac size is usually normal or slightly decreased. The use of non-expandable conformers is possible with good results. Patients treated with hydrogel expanders can wear a prosthesis earlier and with better cosmetic results. In congenital anophthalmia the conjunctival sac is very small and contracted and patients cannot wear a prosthesis or even a conformer. Hydrogel expander treatment--first for the conjunctival sac and second for the orbit--is the therapeutical option which may lead to good cosmetic results. Children >5 years of age and/or unsuccessful pre-treated cases may benefit from osteotomy to reduce mid-face asymmetry. To attain the main therapeutical goal in this subgroup, the ability to fit a normal prosthesis, a combination of different techniques like hydrogel expanders, dermis fat graft, lid surgery etc. may be necessary.

[Treatment of congenital clinical anophthalmos with high hydrophilic hydrogel expanders]. / Therapie des kongenitalen klinischen Anophthalmus mit hoch hydrophilen Hydrogelexpandern.

INTRODUCTION: Children presenting with congenital anophthalmos usually develop a smaller bony orbit, a constricted mucosal socket, and a shortened eyelid fissure. This causes problems when fitting these patients with a prosthesis. Clinical evaluation of the Wiese self-inflating hydrogel expanders has demonstrated their ability to expand the socket and eyelid fissure for inserting a more realistic prosthesis in shorter periods of time. PATIENTS AND METHOD: The study included 13 consecutive anophthalmic patients, eight unilateral and five bilateral. Each patient received a hemispherical osmotic tissue expander in the rudimentary mucosal socket and later a sphere implanted in the deeper soft orbital tissue. RESULTS: The use of hydrogel expanders enlarged the lid and palpebral fissure in all children, with good cosmetic results. It allowed insertion of custom-made glass prostheses with good cosmetic appearance very early in life. Growth of the bony orbit may be stimulated successfully by these expanders in the soft orbital tissue. CONCLUSIONS: The enlargement of constricted mucosal sockets and short palpebral fissures using self-inflating hydrogel expanders is a new and successful concept in treating congenital anophthalmos.