Rehabilitation of unilateral loss of eye with customized ocular prosthesis: Case series

Kirti Jajoo Shrivastava; Saurabh Shrivastava; Naveen S Yadav; Saroj Gupta

doi:10.4103/ijdr.IJDR_499_17

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CASE REPORT

Year : 2020 | Volume : 31 | Issue : 2 | Page : 326-330

Rehabilitation of unilateral loss of eye with customized ocular prosthesis: Case series

Kirti Jajoo Shrivastava¹, Saurabh Shrivastava², Naveen S Yadav³, Saroj Gupta⁴
¹ Department of Prosthodontics, People's College of Dental Sciences and Research Centre, Bhopal, Madhya Pradesh, India
² Department of Prosthodontist, Smile Gallery Dental and Maxillofacial Rehabilitation Centre, Bhopal, Madhya Pradesh, India
³ Department of Prosthodontics, People's Dental Academy, Bhopal, Madhya Pradesh, India
⁴ Department of Opthalmology, AIIMS, Madhya Pradesh, Bhopal, India

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Date of Submission	08-Sep-2017
Date of Decision	07-Mar-2018
Date of Acceptance	05-Jun-2019
Date of Web Publication	19-May-2020

Abstract

A patient who is suffering from complete loss of one eye or one phthisical eye due to injury, inflammation, or tumor experiences lot of physical and psychological trauma. Ocular prostheses are used in the management of a wide variety of acquired and congenital anopthalmia. Several techniques have been used in fitting and fabricating artificial eyes. These eyes can be prefabricated or custom made, but a prosthesis that is lifelike in appearance provides a sense of psychological security to the patient, which is better achieved with custom ocular prosthesis. This article discusses series of cases made by utilizing one of the latest techniques of iris duplication (digital imaging) and also aims at enhanced awareness of the cosmetic benefits of custom designed ocular prosthesis when compared with stock eye.

Keywords: Aesthetics, artificial eye, digital iris, stock eye

How to cite this article:
Shrivastava KJ, Shrivastava S, Yadav NS, Gupta S. Rehabilitation of unilateral loss of eye with customized ocular prosthesis: Case series. Indian J Dent Res 2020;31:326-30

How to cite this URL:
Shrivastava KJ, Shrivastava S, Yadav NS, Gupta S. Rehabilitation of unilateral loss of eye with customized ocular prosthesis: Case series. Indian J Dent Res [serial online] 2020 [cited 2023 Mar 20];31:326-30. Available from: https://www.ijdr.in/text.asp?2020/31/2/326/284574

Introduction

The loss or absence of eye, due to irreparable trauma, tumor, a painful blind eye, sympathetic ophthalmia, or a congenital defect leaves a person grappling not only with a functional disability but also the discouraging effect of impaired facial esthetics.^[1],[2] Replacement of the lost eye as soon as possible after healing, by a prosthesis that is lifelike in appearance, provides a sense of psychological security to the patient, and the physical wearing comfort becomes a primary prerequisite for the patient.^[3] Ocular prostheses are used in the management of a wide variety of acquired and congenital anopthalmia, often after evisceration, enucleation, or orbital exenteration. These eyes can be prefabricated or custom made.^[4] A multidisciplinary management and team approach, including the ophthalmologist, the plastic surgeon, and the maxillofacial prosthodontist are essential in providing accurate and effective rehabilitation and follow-up care for the patient.

This article aims at enhanced awareness of the cosmetic benefits of custom designed ocular prosthesis by showing series of cases.

Summary of Cases

We are hereby discussing ten patients (seven males and three females, aged 12–58 years) who were given customized ocular prosthesis [Figure 1]e, [Figure 1]f, [Figure 1]g, [Figure 1]h, [Figure 2]b, [Figure 2]d and [Figure 2]g, [Figure 3]d, [Figure 3]e,[Figure 3]f These cases can be briefly discussed and shown by dividing them under following categories:

Figure 1: (a-d) Loss of eye due to road traffic accident (pre operative view) and (e-h) Custom ocular prosthesis placed (post operative view)

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Figure 2: (a, c, and e) Patients with stock eye; (f) sling suture placed to recontour lower eyelid; and (b, d, and g) custom eye prosthesis placed

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Figure 3: (a-c) Patients with pthisical eye and (d-f) after custom eye prosthesis placement

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First, on the basis of cause of loss of eye, in four patients, it was found to be road traffic accident [Figure 1]a, [Figure 1]b, [Figure 1]c, [Figure 1]d, whereas others had chemical injury, electric bulb injury, domestic accident, and congenital anopthalmia. Among these, only three patients were wearing stock eye [Figure 2]a, [Figure 2]c, and [Figure 2]e and three patients had phthisical eye [Figure 3]a, [Figure 3]b, [Figure 3]c.

One patient initially reported with sagging of lower eyelid with stock eye which was first contoured following occuloplasty procedure and then customized prosthesis was given which significantly improved the appearance and retainability of prosthesis [Figure 2]e, [Figure 2]f, [Figure 2]g.

Procedure

After thorough clinical examination and consent with an ophthalmologist as well as patients, patients with healed and healthy anopthalmic sockets or with phthisical eyes indicated for prosthesis were counseled and explained procedure for fabrication of customized ocular prosthesis using latest digital iris fabrication technique (Ioli-Ioanna Artopoulou 2006)^[5] for iris duplication and conventional method of characterization.

The impression was made by conventional method using ophthalmic impression material with custom fabricated acrylic resin tray [Figure 4]a and [Figure 4]b. The patient was seated upright with eyes open followed by upward, downward, right and left, and circular movements. Model was obtained and wax pattern [Figure 4]c was made using a conventional three-pour technique, which was then evaluated for contours, mobility, and comfort.
Digital photograph of the patient's iris using a digital camera (Nikon D5200: Tokyo, Japan) with a macro lens (Lens AF-S Nikor 50 mm 1:1.8G) and a ring flash (Newer Macro Ring Flash 550) was taken. Then, using graphics software (Photoshop 7.0; Adobe Systems Inc., San Jose, CA) patient's iris photograph was adjusted for slight differences in color, brightness, contrast, or hue, and image was formatted [Figure 4]d.
Print out of final iris image was taken out on 20-lb white paper with brightness 85 (HP Office; Hewlett-Packard, Palo Alto, CA) using a laser printer (HP Deskjet 950C; Hewlett-Packard), which was then attached to the ocular disk and clear corneal button with monopoly syrup (J-305: Factor II) [Figure 4]e. The ocular disk with sealed iris was inserted into the wax pattern.
After final evaluation of wax pattern for iris guage, iris position, and eye contours in patient, wax pattern was flasked with acrylic rod [Figure 4]f, so as to restore the position of iris during further processing and dewaxed followed by packing with clear and scleral heat-cured acrylic resin (Factor II Inc) along with characterization (Flocking agents and Red Rayon threads Factor II, Inc.) [Figure 4]g and [Figure 4]h. It was then cured, finished, and polished [Figure 4]i and [Figure 4]j.

Figure 4: (a) Custom made Acrylic resin tray; (b) impression made with opthalmic impression material; (c) wax pattern made on master cast; (d) print out of iris images; (e) final iris attached to the ocular disk and clear corneal button with monopoly syrup; (f) flasking of final wax pattern with acrylic rod; (g) packing of clear resin with characterization; (h) packing with scleral heat-cured acrylic resin; (i) cured prosthesis; and (J) finished and polished custom made ocular prosthesis

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Patients were given instructions for insertion and removal of prosthesis and its maintenance. Patients were asked to clean their hands before insertion and removal of prosthesis. It was advised to clean the prosthesis with a mild disinfectant soap or solution at least once a day. The patients were instructed to wear the prosthesis in day time and remove it at night for initial few days, later it can be removed in two to three days depending on hygiene maintenance of prosthesis and patient comfort. To improve the movements of prosthesis and to prevent accumulation of dirt or build-up of deposits on the surface of prosthesis, use of an ophthalmic lubricant was advised.

After 6-month follow–up, all patients were highly satisfied with the use of prosthesis [Figure 2]b, [Figure 2]d, and [Figure 2]g and [Figure 3]d, [Figure 3]e, [Figure 3]f. Few patients, however, complaint of increased secretions or dryness for initial 1 month, which was controlled with medicines. All school and college going students experienced lot of social acceptance by their peer group.

Discussion

Artificial eyes have been in existence since the very early times in Egypt before 3000 BC. Excavation of tombs provided evidence of eye replacement by using precious stones, earthenware, enameled bronze, copper, and gold in the shrunken sockets.^[4] In the 16^th century, Pare fabricated an ocular prosthesis (“emblepharon”) made of gold or silver. Pare' also used glass and porcelain for eyes, which was a great step forward and resulted in the use of the shell type of pattern rather than spheres. Glass remained the most popular material until the advent of World War II, when it was difficult to obtain glass or glass eyes from Germany. Methyl methacrylate, which had already replaced vulcanite as a denture base material, seemed to be a good replacement material. A definitive technique for fabricating artificial eyes using acrylic resin was developed by the United States Naval Dental and Medical Schools and was published in 1944.^[4],[5]

Several techniques have been used in fitting and fabricating artificial eyes.^[6] Unlike glass eyes, the acrylic resin eyes are solid, lightweight, easy to fit and adjust, unbreakable, translucent, easily fabricated, had intrinsic and extrinsic coloring capabilities, and inert to the socket secretions.^[7] Empirically fitting a stock eye, modifying a stock eye by making an impression of the ocular defect, and the custom eye technique are the most commonly used techniques.^{[6],[7],[8],[9]}

However, custom eye technique is found to be most acceptable. Even the modified stock eye technique does not replicate the esthetic intricacies so well and require additional painting and contouring procedures as has been observed in previous published article.^[10] As compared with stock eyes, custom made prosthetic eyes have several advantages [Table 1] and [Figure 5].^[5],[11] Stock eyes are, thus, known to cause inflammation and discharge due to poor biocompatibility and since stock eyes do not conform to the socket anatomy, cause changes in the socket and lid anatomy and lead to contracted socket.^[12]

Table 1: Custom made prosthetic eyes versus stock eyes

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Figure 5: (a and b) Polished surfaces of stock and custom eyes, respectively and (c and d) tissue surfaces of stock and custom eyes, respectively

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The technique used to replicate iris in this article is digital image of the iris of the adjacent normal eye to give better esthetics in a fraction of time and with much enhanced color stability as compared with that required for painting the iris, which require lot of skill and often initial color stability of few paints is doubtful.^[13] However, special digital photography equipment and settings, as well as computer software that allows for image adjustments, are required for making digital iris.^[5]

Conclusion

Replacement of the lost eye as soon as possible after healing from eye removal is necessary to promote physical and psychological healing of the patient and to improve social acceptance. After 6-month follow-up with customized ocular prosthesis, all patients were highly satisfied with its use. Few patients, however, complaint of increased secretions or dryness for initial one month, which was controlled with medicines. All school and college going students experienced lot of social acceptance by their peer group. In spite of widespread distribution of acquired and congenital anopthalmic or phthisical eye patients, from children to the elderly, number of patients aware of customized ocular prostheses is still very less. The work of the maxillofacial prosthodontist facing the rehabilitation of the patient can be enriched and even made easier with the support of ophthalmologist (as here in this article sling suture case has been shown) along with anopthalmic socket examination of all patients, so as to contribute to better technical intervention.

Declaration of patient consent

The authors certify that they have obtained all appropriate patient consent forms. In the form the patient(s) has/have given his/her/their consent for his/her/their images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.

References

1.	Chiramana S, Anne G, Ravuri K, Boppana PP, Kumar S, Appana KC. A time saving method to fabricate a custom ocular prosthesis. J Oro fac Res 2013;3(Suppl 1):42-5.
2.	Perman KI, Baylis HI. Evisceration, enucleation and exenteration. Clin North Am 1988;21:171-82.
3.	Cabral LG, Martelli Júnior H, Leite DM, Sabatini Júnior D, Freitas AB, Miranda RT, et al. Biopsychosocial profile of patients with anophthalmia in the south of Minas Gerais-Brazil. Arq Bras Oftalmol 2008;71(Suppl 6):855-9.
4.	Jahrling RC. Essentials in fitting ocular prostheses for complex congenital and acquired anomalies. J Am Optom Assoc 1998;69(Suppl 6):357-75.
5.	Artopoulou II, Montgomery PC, Wesley PJ, Lemon JC. Digital imaging in the fabrication of ocular prostheses. J Prosthet Dent 2006;95:327-30.
6.	Murphey PI, Schlossberg L. Eye replacement by acrylic maxillofacial prosthesis. Naval Med Bull 1944;43:1085.
7.	Dyer NA. The artificial eye. Aust J Ophthalmol 1980;8:325-7.
8.	Taicher S, Steinberg HM, Tubiana I, Sela M. Modified stock-eye ocular prosthesis. J Prosthet Dent 1985;54:95-8.
9.	Benson P. The fitting and fabrication of a custom resin artificial eye. J Prosthet Dent 1977;38:532-8.
10.	Tripuraneni SC, Vadapalli SB, Ravikiran P, Nirupama N. An innovative impression technique for fabrication of a custom made ocular prosthesis. Indian J Ophthalmol 2015;63:545-7. [PUBMED] [Full text]
11.	Murthy R, Umesh M. Fabricating a custom made ocular prosthesis. Indian J Ophthalmol 2015;63:807-8. [PUBMED] [Full text]
12.	Fernandes AUR, Goiato MC, Batista MAJ, Santos DMD. Color alteration of the paint used for iris painting in ocular prostheses. Braz Oral Res 2009;23:386-92.
13.	Choubisa D. A simplified approach to rehabilitate an ocular defect: Ocular prosthesis. J Indian Prosthodont Soc 2017;17:89-94. [PUBMED] [Full text]

Correspondence Address:
Dr. Kirti Jajoo Shrivastava
Smile Gallery Dental and Maxillofacial Rehabilitation Centre, C/O Saurabh Nursing Home, 82-Marwari Road, Near Jumerati Gate, Bhopal - 462 001, Madhya Pradesh
India