Ocular Prosthesis

by Sachin Gupta (LVPEI 2006) and Shreya Gupta (BLSO 2006)

Ocular prosthestic rehabilitation boosts patients' confidence and also gives greatest satisfaction to OCULARISTS. Sachin and Shreya writes about Ocular Prothesis, a speciality that optometrists can look forward to as a career option.

About the authors

Mr & Mrs Gupta are successful ocularists from New Delhi, India. Mr Sachin Gupta completed Masters in Optometry from the NIMS University, Jaipur and he is a Fellow Of Optometry from the L V Prasad Eye Institute, Hyderabad. He did his fellowship in Ocularisty from Artificial Eye Services, Perth, Australia. Mrs Shreya Gupta is a graduate from the School of Optometry, Bharati Vidyapeeth University Pune & Fellow Of Optometry from the L V Prasad Eye Institute, Hyderabad.  She did fellowship in Maxillo-Facial Prosthesis from Waikato Hospital, Hamilton NZ. 

They have their own Oculo-Prosthetic Labs under the name of “Art Eyes” in New Delhi, Ambala, and Moradabad, India. They have developed excellent skills and work extremely hard to fine-tune every small detail in the prosthetic eye to make it comfortable and lifelike. They participated in various national and international Ocularist’s conferences & conducted workshops. They clearly love their job crafting artificial eyes.

Sachin and Shreya own Oculo-Prosthetic Labs under the name of “Art Eyes” in New Delhi, Ambala, and Moradabad, India. They have developed excellent skills and work extremely hard to fine-tune every small detail in the prosthetic eye to make it comfortable and lifelike. They participated in various national and international Ocularist’s conferences & conducted workshops. They clearly love their job crafting artificial eyes.

Eyes are the most important part of the facial beauty and generally the first feature of the face to be noted. Unfortunate loss or absence of an eye may be caused by a congenital defect, accident, trauma, tumor or a painful blind eye.

 

Facial disfigurement associated with the loss of an eye can cause significant physical, psychological and emotional trauma. Most patients experience significant stress not only due to the functional disability caused by the loss but also by social reactions to the facial impairment.

 

Replacement of the lost eye as soon as possible is necessary to promote physical and psychological healing for the patient and to improve social acceptance.  A fundamental objective when restoring an ophthalmic socket with an ocular prosthesis is to enable the patient to cope better with the tough process of rehabilitation.

A multi-disciplinary management and team approach are essential in providing accurate and effective rehabilitation and follow-up care for the patient. Therefore, the combined efforts of the ophthalmologist and ocularist are essential to provide a satisfactory ocular prosthesis.

Ocularisty is the art and science of making & fitting a customized artificial eye or ocular prosthesis to a disfigured or lost eye. The role of an ocularist is fabricating an ocular prosthesis with acceptable aesthetics, to restore facial symmetry and normal appearance.

What is Ocular Prosthesis?

Ocular prosthesis or commonly known as artificial eye is  an object  which is fitted in the eye socket post removal of eye due to surgery (Enucleation/Evisceration)  or over a shrunken eye post injury or infection. It is made according to the fellow eye of the patient so that it looks natural.

 

A person who makes custom artificial eyes for one-eyed patients is called an Ocularist.  

Who needs Ocular Prosthesis?

Ocular prosthesis can be a boon to several patients who lost their eye following unfortunate situations. Mainly, people who met with an accident leading to severe damage of the eye and its function and thus leading to shrinkage of that eye. This shrunken, non-seeing eye looks abnormal and can be a point of distraction during eye contact with someone.  Also many a times, an eye infection/injury can lead to people losing their eyesight and in severe cases an ophthalmologist has to remove such an eye to save the other ocular components. These one eyed patients who have no visual potential in an eye and who need cosmetic rehabilitation in that eye, are ideal patients for ocular prosthesis.

A case of 6 years old boy who underwent right eye evisceration with acrylic implantation following infection fitted with custom made ocular prosthesis.

What is the process involved in Ocular Prosthesis?

As the name suggests, a custom ocular prosthesis means that it is custom made for the particular patient. This is done by taking the measurements of the affected socket with the help of silicon. This impression is then duplicated into a wax model which is further carved according to the patient’s fellow eye. The final wax model is then made into an acrylic shell, which is then painted according to the patients other eye to match the appearance. The prosthesis then undergoes lamination and high grade multi-level polishing to be then dispensed to the patient.

A toddler's disfigured eye managed by custom-made ocular prosthesis

What care & maintenance is involved for the prosthetic eye?

A custom made ocular prosthesis does not require a rigorous care regimen. The only point to remember is to maintain the hygiene of the eye per se. The prosthesis needs to be removed once in a month and cleaned with a mild shampoo and then rinsed thoroughly, so as not to cause any irritation to the eye. An overnight soaking of the prosthesis in soft contact lens solution is also recommended once a month to maintain its hygiene. An annual polishing of the prosthesis by an ocularist is also strongly recommended.

 

The prosthesis doesn’t need to be removed on a daily basis, as it custom made so the chances of discharge are very minimal, providing the patient with great comfort. Discharge is usually seen in patients using ready made prosthesis. This occurs because of tear accumulation between the ready made prosthesis and the eye socket. But  in cases of custom made prosthesis, there is no or minimal space between the prosthesis and eye socket, so the tears do not accumulate.

Is it difficult to insert and remove the prosthesis

The insertion of the prosthesis is a very simple technique. The patient is asked to look down and the top of the prosthesis is inserted under the upper lid. The upper lid is then released and the lower lid is retracted till the lower edge of the prosthesis is slightly pushed upward to help this happen. Once the prosthesis is completely in the socket, the eye forms a suction with the prosthesis thus retaining the prosthesis in the socket.

 

The removal of the prosthesis is done by asking the patient to look upwards. The lower lid is then retracted slightly and pressed towards the socket and stretched towards the ear. This action helps bringing the lower lid margin under the prosthesis thus breaking the suction and helping the prosthesis to slide out effortlessly.

 

A custom made ocular prosthesis is a very good option for one eyed patients who need cosmetic rehabilitation. Since eyes are first seen on a person’s face…. Having a good cosmetic outcome is very essential for a person. In most of the cases it is possible to get unrecognizable difference between the two eyes. In children, it is very essential to get prosthesis fitted as soon as possible so as to avoid any kind of facial asymmetry.

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