First described in 1583 by Bartische, exenteration is a complex and disfiguring procedure [1]. It involves the removal of the globe and all orbital contents, including muscles, fat, optic nerve, lacrimal gland, nerves, periorbita [2]. Rare, we report 8 cases over 3 years, i.e., an annual average of 2.6 cases in our series. Zhang Z and colleagues report a frequency of 2.5 cases per year in their series [3]. The average age in our series is 63.5 years, which corresponds to many authors [4-6]. Male predominance is accepted by all [7].

Orbital exenteration is indicated in the treatment of malignant tumors invading the orbit. It was only CBC in our series. BCC is the most common indication for orbital exenteration worldwide, followed by squamous cell carcinoma, melanoma, sebaceous carcinoma, lacrimal gland carcinoma [8-10]. Recently, more and more authors [11-12] adopt globe-sparing surgery combined with radiotherapy in extensive BCCs with orbital extension. This protocol seems to give encouraging results at the cost of serious complications (disabling diplopia, keratitis, radiological retinopathy, optic neuropathy, neovascular glaucoma) sometimes justifying secondary enucleation. Targeted therapies also, notably Vismodegib, alone or as neoadjuvant treatment in extensive BCC, also seem to give interesting results with significant side effects [13-15]. The protocols are not yet properly defined.

Regarding orbital exenterations, although many classifications exist, there are 3 essential types. Total orbital exenteration which concerns the entire orbital contents and the eyelids, sub-total exenteration which preserves the eyelids and enlarged exenteration which extends to neighboring structures (bony walls of the orbit, sinus cavities, cranial cavity) [2].

The aim of the reconstruction is to obtain a bowl-shaped appearance of the orbital socket, ideal for the subsequent placement of the prosthesis. The means of reconstruction are numerous. Directed healing requires several months of follow-up before obtaining the expected result [16]. There are also skin grafts, dermal fat graft, artificial dermis graft, loco-regional flaps (superficial temporal flap, temporalis muscle flap, galeal or pericranial flap), free flaps (radial forearm flap, anterolateral thigh flap, latissimus dorsi flap and microvascular scapula flap) [17].

Once the expected result has been achieved, aesthetic rehabilitation is necessary. It is mainly based on orbital prostheses, although some patients prefer to wear an eye patch. Osseointegrated prostheses constitute the gold standard today, a principle described for the first time by Branemark in 1969 [18]. Their installation takes place in 2 stages: the installation of the orbital implants in the socket then that of the pillars 3-4 months later [19]. Patients are generally satisfied with their prostheses when they are made by specialized anaplastologists. Peri-implant hygiene must be rigorous.