Congenital microphthalmia is a developmental disorder of the eye, which is characterized by an overall small eye, varying in size depending on the condition. In mild cases, the eyeball is slightly small, with normal or mild defects at all levels of structure and some vision; in severe cases, the eyeball is extremely small, such as a green bean or even difficult to find (the clinical diagnosis is “congenital anophthalmia”), and the structure of the eyeball is incomplete, with very poor or no vision. In congenital microphthalmia, not only is the eye small, but also the appendages of the eye, including the conjunctival sac and orbit, are small, and even the affected side of the eye is smaller than the healthy side. However, as we can observe clinically, the appearance of these small eyes on one side generally has no obvious ocular depression or only mild orbital depression because the orbital volume is also small, which is appropriate relative to the small eye, that is, the volume of the small eye matches the volume of the small orbit (because the development of the orbit depends on the development of the eye). Several patients shown in Figures 1 to 4 above were congenitally small, but no significant sulcus on the side of the small eye was visible. This condition is distinctly different from the sunken eye sockets presented after acquired eye removal surgery. The picture above shows the eye removal after ocular trauma, and you can see the very obvious sulcus of the eye socket. Therefore, congenital small eye, should try to retain the affected eye based on wearing a prosthetic eye to improve the appearance, because: 1. congenital small eye also has a small orbit, and the implanted eye table after removal usually can not accommodate a large eye table, and the surgical trauma may also cause complications such as conjunctival sac stenosis. 2. Congenital microphthalmos generally does not affect the good eye and there is no need to remove it. Of course, if congenital microphthalmos is combined with intraorbital cysts or other disorders such as secondary endophthalmitis, removal surgery should be considered according to the condition. The above picture shows a patient with congenital microphthalmos who underwent local surgery to remove the eye and implant an eye table. Due to the large size of the implanted eye table, the soft tissues in the interior of the eye socket were pushed to the outside of the orbit, and the conjunctival sac was narrowed, which not only prevented the wearing of a prosthetic eye, but also made the subsequent plastic surgery extremely difficult. The above picture shows another patient with congenital microphthalmia in which the local eye was removed and an eye table was implanted, and the soft tissues of the eye were clearly protruding anteriorly, making it impossible to fit a prosthetic eye; the CT film shows that the left (L) orbit is clearly narrow and completely filled by the eye table (white round solid shadow). When the orbit was completely filled with the eye table, the soft tissues inside the original orbit were of course squeezed to the front, resulting in the inability to fit the prosthetic eye. In this case, the eye socket can only be removed, but the removal of the eye socket is bound to cause damage, and many problems such as narrowing of the conjunctival sac and inversion or ectropion of the eyelid may occur after surgery. Due to all of the above, congenital microphthalmia should not be removed lightly! In particular, the eye table should be implanted with caution, and the appropriate size should be carefully chosen if the eye needs to be removed and an eye table implanted.