Orbital Implant Surgery with Costal Cartilage Graft Is Associated with Better Symmetry and Improved Cosmetic Appearance

Background: In Japan, artificial orbital implant materials are not approved for medical use, limiting orbital implant surgery to select centers. However, this procedure can improve the quality of life for ocular prosthesis users. This study evaluates the cosmetic advantages of orbital implant surgery using autologous costal cartilage by comparing upper eyelid symmetry between patients who underwent the surgery and those who did not. Methods: A retrospective cohort study was conducted on ocular prosthesis users at a single institution. Patients were divided into two groups: those who underwent orbital implant surgery with costal cartilage (Group 1) and those who used a prosthetic eye without an implant (Group 2). Upper eyelid position, pre- and postoperative complications, and demographic/clinical characteristics were analyzed using Mann–Whitney U and chi-squared tests, with statistical significance set at p < 0.05. This study was approved by the Clinical Research Review Committee of Tokai University (approval number 24R077-001 MH). Results: The study included 23 patients (Group 1: n=13, Group 2: n=10). Group 1 had a significantly lower median age (52 vs. 68 years, p=0.002) and a higher proportion of females (76.9% vs. 30%, p=0.024). Upper eyelid asymmetry was significantly greater in Group 2 (p<0.05). Orbital fracture was associated with a higher risk of requiring additional surgery (100% vs. 37.5%, P=0.075), though not statistically significant. Conclusions: Orbital implant surgery with costal cartilage grafts improves eyelid symmetry and cosmetic appearance. Early and accurate orbital volume repair is essential for preventing enophthalmos.