The coral-derived hydroxyapatite sphere is a popular, new integrated orbital implant designed to provide improved motility of the ocular prosthesis following enucleation. Although the implant has rapidly become widely used by ophthalmologists, there is little information available regarding the complications of this technique in a large series of cases. We report our results on our initial 250 consecutive cases of hydroxyapatite implantation for eyes enucleated primarily for intraocular neoplasms, with specific emphasis on the complication an their management. The reasons for enucleation included uveal melanoma (157 cases), retinoblastoma (70 cases), blind painful eye (22 cases), and intraocular medulloepithelioma (1 case). Prior treatment to the eye was performed before enucleation in 47 cases and included repair of ruptured globe (17 cases), plaque radiotherapy (18 cases), external beam radiotherapy (6 cases), and others (6 cases). During a mean of 23 months follow-up (range, 6 to 42 months), there have been no recognizable cases of orbital hemorrhage related to the implant and no cases of implant extrusion or implant migration. There was one case of presumed orbital infection (culture-negative) that resolved with intravenous antibiotics, and the implant was retained within the orbit. Other problems included conjunctival thinning in eight cases managed by observation and prosthesis adjustment and conjunctival erosion in four cases managed by combinations of scleral patch graft, conjunctival flap, and prosthesis adjustment. The conjunctival erosion was caused by a poorly fitting prosthesis in three cases and wound dehiscence in one case. The complication rate in eyes receiving prior radiotherapy or surgery was not increased. The hydroxyapatite integrated orbital implant is a well-tolerated motility implant without the high rate of extrusion and infection seen with other motility implants.