T HE EXTRUSION of an orbital implant is usually accompanied by a low-grade infection in the orbital tissues. In some patients, the infection can be controlled by intensive antibiotic therapy, and healing occurs with minimal scarring of the conjunctiva. In others, a more severe fibroblastic reaction produces webs and bands of scar tissue behind the conjunctiva and involving it. These bands eventually contract, reducing the size of the socket so that a prosthesis cannot be worn. In most cases even a modified prosthesis does not produce the desired cosmetic result, and surgery is necessary to relieve the enophthalmic appearance and the exaggerated lid fold. The contracted socket must be enlarged, the scar tissue excised, and, if possible, an orbital implant reinserted. The usual surgical approach has been through the conjunctiva, an area where a sterile field is difficult to obtain, so that in many instances the second implant is also