Purpose

To describe the clinical course and management of a patient presenting with progressive lower eyelid cicatricial ectropion decades after orbital fracture repair and to highlight very late implant extrusion as a potential consequence of long-term bony remodeling.

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Methods

A 75-year-old man with a history of orbital fracture repair 28 years earlier presented with left lower eyelid eversion, epiphora, and blurring of vision. Examination showed cicatricial ectropion, inferior conjunctival keratinization, and exposure keratopathy. Computed tomography demonstrated facial bony deformity without retained implant material, consistent with prior implant loss. Surgical management consisted of cicatrix release and lateral tarsal strip tightening.

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Results

Clinical history revealed gradual implant loosening over several years, followed by spontaneous extrusion and unsupervised removal of exposed fragments. The excised scarred tissues showed dense cicatricial changes without residual hardware. Surgical correction restored eyelid–globe apposition and ocular surface protection. At follow-up, eyelid position remained stable with symptomatic improvement and no recurrence of malposition.

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Conclusion

Very late orbital implant extrusion is uncommon but may occur decades after fracture repair. Progressive bony remodeling and long-term tissue adaptation may reduce implant stability, leading to gradual loosening and biologic extrusion rather than acute failure. Subsequent scarring may result in severe secondary eyelid deformity. This case highlights the need for lifelong vigilance in patients with prior orbital implants and supports timely surgical intervention to prevent progressive cicatricial morbidity.

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Additional Authors

First name	Last name	Base Hospital / Institution
Mariel Angelou	Parulan	Quirino Memorial Medical Center

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