INFECTION AFTER INSERTION OF ALLOPLASTIC ORBITAL FLOOR IMPLANTS

Ten patients developed infections after alloplastic implantation (nine silicone, one gelatin film [Gelfilm] implant) for orbital floor fract ure repair. Infection resulted from the following: (1) dental surgery, (2) upper respiratory infection, (3) inferior extrusion of a retained implant into the maxillary sinus with a fistulous tract into the infe rior conjunctival fornix, (4) rhinoplasty, (5) snorting cocaine and ot her drugs, (6) postoperative infection after orbital floor repair, and (7) medial implant migration resulting in chronic dacryocystitis. In all ten patients, implants were removed because of orbital abscess, re current infection, or chronic low-grade infections. Microbiologic cult ure of removed implants disclosed Staphylococcus aureus, S. epidermidi s, Serratia marcescens, and Pseudomonas aeruginosa as the offending or ganisms. The main complication of infection included severe cicatricia l ectropion of the lower eyelid in three patients. The final globe pos ition was not adversely affected by implant removal performed from fiv e months to 20 years after insertion. Guidelines for prevention and ma nagement of orbital implant infections based on these ten patients are presented.