Ocular Prosthesis
Ocular prostheses are durable medical equipment made out of acrylic. They are used to maintain socket health and lid function after an individual has had one or both eyes removed, the health of one or both eyes has deteriorated, causing them to shrink, or they were born without one or both eyes.
The Types of Ocular Prostheses
Traditional
A traditional ocular prosthesis is necessary after the removal of your eye through enucleation or evisceration.
To create an ocular prosthesis, a multi-step process is performed over three appointments, spanning two days. The first day is when the main parts of the prosthetics are made.
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The first appointment on the first day consists of three steps. The first step is for the ocularist to take an impression of the socket using an alginate material to get all the contours, ensuring the best possible fit. The second step involves painting the background of the iris. This is when the Ocularist paints the background colors of your iris on a black disk. The third step is the wax pattern fitting. The Ocularist will use the impression taken to create a red wax pattern that can be molded and sculpted to position the painted iris button correctly, ensuring the proper direction of gaze and pupil symmetry.
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During the second appointment, the detailed work starts. The ocularist uses earth pigments to paint the iris and tint the scleral tones to match the natural color of your eye. Then, they will use red silk thread to recreate the appearance of blood vessels. After the artwork is complete, the patient will leave for the evening, when the paint will dry and be prepped for the final processing.
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The third and final appointment is when you’ll receive your finished prosthetic, and your ocularist will assist you in putting it in. If you have any questions, now is a great time to ask your Ocularist, as you’ll be heading home with your prosthetic after this appointment.
Thin or Scleral Shell
Thin ocular prostheses are a specialty form of ocular prosthesis that covers an eye that has not been removed and may or may not have sensitive corneal tissue.
The process is very similar to making a traditional ocular prosthesis, but with a few minor differences.
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The condition of the globe determines the process of making a thin prosthesis. During the consultation, your provider will do a corneal sensitivity test and determine if you’re a candidate for having a prosthesis made.
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After the consultation, most patients need to test wear a trial lens. This lens is made by taking an impression of your socket, so it’s a custom fit for you. This appointment is about 45 minutes. You’ll come back, ideally the next day, to pick up your lens and begin wearing it. Before we can proceed with creating a custom prosthesis for you, you must be able to wear your trial lens for at least 12 hours a day, or all waking hours.
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At the fourth appointment, the Ocularist will take another impression of the socket to capture all its contours and achieve the best possible fit. Then there will be a background painting of the iris on a black disk. Then, a wax pattern will be created from the impression to embed the iris disk, ensuring accurate direction of gaze and pupil symmetry. After the iris is positioned correctly in the wax, this appointment is complete.
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The fifth appointment takes place the afternoon of the first appointment and consists of all artwork. The wax pattern has been converted into white acrylic, and now, detail work needs to be done in the iris painting, as well as tinting the scleral tones to match and using red silk thread to recreate the appearance of blood vessels. After the artwork is complete, the patient will leave for the evening, allowing the paint to set and be prepared for final processing the morning of the next appointment.
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The final appointment is on the second day, where the paint has dried and the Ocularist has added a clear coat of acrylic over the paint and polished the acrylic to be as smooth as possible, providing comfort for the prosthesis for the patient.
Expansion Therapy
Expansion Therapy is the process of gradually expanding a microphthalmic or anophthalmic socket to promote the normal growth of the orbit and other cranial structures through the use of ocular conformers. These conformers become progressively bigger until there is a space large enough to make a full-size ocular prosthetic.
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During an Examination Under Anesthesia (EUA), the Ocularist will work in tandem with the doctor to examine the socket and take an impression of it. This impression will be used by the ocularist to create a shape, initiating the expansion process. Approximately a week after the EUA, the patient will visit the Ocularist to have the first expansion form placed in the socket. Then, about every two to three weeks, a slightly larger form will be placed as the patient’s orbit grows. Once the socket size has become large enough then the process of creating an ocular prosthetic will begin.
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Follow-ups are crucial to the success of these cases to ensure proper expansion. Depending on how easily accessible the Ocularist is, many forms can be created so that parents can replace the new shapes as the old ones become too small. Close communication between the Ocularist, family, and Oculoplastic surgeons or Ophthalmologists is key to a successful result.
