This review outlines many of the recent advancements in the understanding and management of the anophthalmic patient. A population-based study demonstrated that the annual incidence of enucleations for all causes was about 3 to 5 per 100,000. Application of expandable orbital implants appears to be promising in the management of microphthalmia or anophthalmia in infants to maximize orbital growth. Some reports on the use of hydroxyapatite enucleation implants are encouraging, with no major complications observed in one large series. Yet other reports of hydroxyapatite implant exposures, at a very concerning frequency, are also beginning to emerge. Few of the exposures heal spontaneously; however, infections or extrusions are very rare, and they are attributable to the porous composition of the implant. Conjunctival flaps alone are suboptimal in the management of exposures. Adjunctive autologous fascial grafts seem preferable to heterologous sclera in the management of these exposures. Magnetic resonance imaging of the hydroxyapatite implant appears to be superior to bone scan in the noninvasive assessment of vascularization of these implants. Further advancements are necessary to achieve a more optimal enucleation implant.