Purpose: To determine the incidence and risk factors of complications associated with Supramid orbital implants. Methods: A retrospective chart review was performed to document complications in a series of 41 patients receiving Supramid implants during orbital reconstruction or fracture repair. Implant size, duration of time between trauma and implant insertion, and history of prior orbital surgery were examined as possible risk factors for the development of complications. Results: Four patients had hemorrhage within the implant capsule. An orbital abscess developed in a single patient. All but one complication appeared 7.8 to 10 years after implant insertion. Patients who had complications had a longer duration of time between trauma and implant insertion than those in whom complications did not occur (P=0.0019). Complications were more frequent among patients with larger (>600 mm2) implants and a history of orbital surgery. Conclusions: Spontaneous infection or hemorrhage may occur within the capsules of Supramid orbital implants, even many years after surgery. The insertion of larger implants in the late repair of extensive bony orbital defects may predispose patients to these complications. Implant removal and marsupialization of the implant capsule to the maxillary sinus appears to be curative without causing significant postoperative enophthalmos.