Contracted Socket classifications

Contracted Socket Classification

There have been many attempts to classify contracted sockets but no system has fully been adopted.

One of the earliest and straightforward classification systems was proposed by Vistnes and Iverson in 1974:

Minor Socket Defects

a) Socket scars without eyelid connections

b) Sockets scars connected to an eyelid margin, with or without notching

Major Contractures of the Socket

In 1980, Krisha et al. proposed a unique grading system:
The soft tissue sockets were divided into five grades for the sake of convenience in management of contracted sockets.

Grade 0	Socket is lined with healthy conjunctiva and has deep and well formed fornices.
Grade 1	Shallow lower fornix or shelving of the lower fornix.
Grade 2	Loss of the upper and lower fornices.
Grade 3	Loss of the upper, lower, medial, and lateral fornices.
Grade 4	Loss of all the fornices and reduction of palpebral aperture in horizontal and vertical dimensions.
Grade 5	Recurrence of contraction of the socket after repeated trials of reconstruction.

Guyuron in the series Advances in Ophthalmic Plastic and Reconstructive Surgery states the following :

Class I	These are the patients that only have insufficient lining of the eye socket, no enophthalmos, no soft tissue or bony deficiency of the orbit or periorbital area.
Class II	These patients have insufficient eye socket lining as well as deficiency in the soft tissue of the orbital content, so that even after the eye socket is successfully reconstructed the prosthetic eye will look enophthalmic.
Class III	These patients not only have deficiencies of the eye socket and orbital soft tissue, but are also deficient in growth of the periorbital tissues and bones.

An updated classification was proposed by Tawfik et al. in 2009:

Grade 1	Minimal or no actual contraction. Patients usually complain of inability to retain the prosthesis for a long time. Horizontal lid laxity is usually observed in these patients, with subsequent prolapse or retraction of the inferior fornix. Patients with an unusually large or anteriorly displaced implant also  fall in this category.
Grade 2	Mild contracture of the inferior and/or the superior fornix. Patient either  complains of inability to wear the prosthesis or may complain of a cosmetic disfigurement due to rolling-in of the upper and lower eyelid margin.
Grade 3	More advanced scarring than grade 2. Cicatrization generally involving the entire upper and lower fornices. Wearing the prosthesis is impossible.
Grade 4	Severe  phimosis of the palpebral fissure both vertically and horizontally. Recurrent  cases and irradiated sockets are also included in this category.

Source: EyeWiki

Gopal Krishna

The soft tissue sockets were divided into five grades for the sake of convenience in management of contracted sockets.

Grade-0: Socket is lined with the healthy conjunctiva and has deep and well formed fornices.

Grade-I: Socket is characterized by the shallow lower fornix or shelving of the lower fornix. Here the lower fornix is converted into a downwards sloping shelf which pushes the lower lid down and out, preventing re­tention of a artificial eye [Figure - 1].

Grade-II: Socket is characterized by the loss of the upper and lower fornices, [Figure - 2].

Grade- III: Socket is characterized by the loss of the upper, lower, medial and lateral fornices [Figure - 3].

Grade-IV: Socket is characterized by the loss of all the fornices, and reduction of palpebral aperture in horizontal and vertical dimensions [Figure - 4].

Grade-V: In some cases, there is recur­rence of contraction of the socket after re­peated trial of reconstruction [Figure - 5].

Source: IJO

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