Can Ear Cartilage Be Used For Orbital Floor Augmentation?

Q: Dr. Eppley, I am interested in orbital floor augmentation to raise up my eye which is about 2 to 3mms lower than the other side. Regarding the graft material, I’d prefer to go with natural ear cartilage if that’s something you’re comfortable using. Have you used ear cartilage for orbital floor augmentations before? I also have several more questions about this procedure…

1. Could raising the eyeball via the orbital floor (as opposed to reconstructing the entire orbit in a different position) result in pressure on the upper part of my eye?

2. Is there any chance of this procedure affecting my vision?

3. How long would I have to abstain from wearing my contact lenses?

4. Could this result in unintentional horizontal movement, in addition to vertical movement? Is there any chance of ending up with a cross-eyed look?

5. Approximately how long will it take for my eye to settle in its final position, about 2mm higher than where it is now?

6. Approximately how long will the procedure take and how long will I be under anesthesia for?

7. Is there any way to do before/after 3-D imaging for this procedure? I think what I’m seeing in my head is a complete relocation of my entire eye – I’m having some trouble visualizing what it would look like just to have my left eyeball raised, while my eyelids, lashes, etc. remain in the same position.

A: Cartilage can be used for orbital floor augmentation and certainly would be a natural material. I am all for using a natural material when possible. Cartilage has the advantage somewhat similar to a synthetic implants in that it should not undergo any resorption. The only issue with ear cartilage is that the amount of graft material is fairly limited. Ear cartilage is great for the nose but the front part of the orbital floor is much bigger. Thus the only caveat is that the ear graft size may be somewhat insufficient for its intended purpose. In answer to other questions:

  1. This amount of orbital floor augmentation will not put any undue pressure on the eye.
  2. There is no risk of vision loss with this procedure.
  3. You can wear your contacts as soon as you feel comfortable and can get them in.
  4. The procedure will not result in any unintended horizontal movement.
  5. The final results from orbital floor augmentation can be critically judged 6 weeks later. Always the eye will look a little higher than the ‘normal’ eye for awhile.
  6. This is a one hour procedure done under general anesthesia.
  7. Computer imaging can be done of the eye moving up but it will create a distorted view. Computer imaging can only show more or less of what is already present. Thus moving the eye up should show a similar amount of iris exposure but it will look elongated and will not show a natural iris to lower lid margin relationship. I am happy to do it but you will probably not find it helpful.

Dr. Barry Eppley

Indianapolis, Indiana