ALL YOU NEED TO KNOW ABOUT PROSTHETIC EYE AND ENUCLEATION SURGERY

The main purpose of a prosthetic eye is to create a more natural and balanced facial appearance, filling the eye socket where the eye is missing.

This option is preferable to wearing an eye patch or bandage if a patient loses an eye.

Having a prosthetic eye will immediately boost your confidence following the loss of an eye.  Also, it is easy and comfortable to wear and maintain.

You can use your ocular prosthesis during your everyday activities. You can even still cry since your eyes can make tears in the eyelids.

What Is A Prosthetic Eye?

An ocular prosthesis, glass eye, or artificial eye replaces an absent natural eye following surgical eye removal. This includes a procedure called enucleation and evisceration surgery.

Enucleation surgery is the medical term for the surgical removal of the entire eyeball.

Conversely, evisceration is the procedure where the eye’s contents are removed, leaving the outer white shell (sclera) with eye muscle attachments intact.

After the natural eye is removed, the new prosthetic eye fits over an orbital implant and goes under the eyelids.

It works as a ball-and-socket joint. So, it is not a simple glass sphere.

Prosthetic eyes are used to improve your facial appearance after you lose an eye due to trauma, eye injury, eye cancer, severe infection, or advanced glaucoma. Also, prosthetic eyes are used in any condition that causes permanent, unmanageable pain in a blind eye that needs to be removed.

An ocular prosthesis does not provide vision, though. A patient with an ocular prosthesis will remain blind on the affected side and have a monocular (one-sided) vision.

In some cases, instead of an ocular prosthesis, you could use painted contact lenses or a “scleral shell,” which can be used over a damaged or eviscerated eye.

What Are Prosthetic Eyes Made Of?

Even though they are often referred to as glass eyes, prosthetic eyes are made of PMMA (polymethyl methacrylate) or medical-grade plastic acrylic. A few ocular prosthetics today are actually made of cryolite glass.

The prosthetic eye is shaped like a shell and fits over an orbital implant.

The orbital implant is a separate, rounded, hard device surgically placed and permanently embedded deep in the eye socket.

Then, six to ten weeks after your orbital implant surgery, you will have to visit an ocularist to be fitted for your prosthetic eye.

Ocularists are technicians in charge of fitting and shaping prosthetic eyes. But they also must be skilled artists who can create eyes that look natural by adding painted irises and pupils.

The pupil on the artificial eye cannot change, though, so the pupil’s size on your natural eye may not always match your prosthetic eye.

This happens because pupils dilate and vary in size depending on lighting conditions and other factors.

Nevertheless, modern technology allows for the appearance of the prosthetic eye implant to be as natural as possible with a dynamic pupil.

This system has a unique mechanism that compresses or dilates the pupil depending on the light conditions. In this way, the artificial eye can look as realistic as possible.

Photonic Ocular Prosthesis

Currently, Art-lens produces prostheses with dynamic pupil.

This system has a mechanism that compresses or dilates the pupil depending on the light conditions.

Prothèse oculaire après éviscération de l’œil.

Why Choose Art-Lens Ocularists?

Since 1982, Art-lens has been the reference center in Spain for the manufacture and installation of prosthetic eyes. They are custom made, after the impression is taken, and look completely real.

The team of ocularists optimally adapts the shade, shape and size of the prosthesis to those of the healthy eye.

Ocularists work in direct collaboration with the team of ophthalmologists. The goal is to choose the ocular prosthesis that best suits the patient’s needs.

You can request express delivery. To shorten your stay in Barcelona, ​​it is possible to manufacture and deliver it within 24 hours. If you would like to know the support, please fill out the contact form.

OCULARISTS AT ART-LENS:

Àlex Gutiérrez Pérez

Àlex Gutiérrez Pérez

Patricia Gil Campos

Patricia Gil Campos

Aaron Olmo Vergely

Aaron Olmo Vergely

Silvia Carballo Jardon

Silvia Carballo Jardon

Types Of Ocular Implants

There are many different types of implants, going from spherical vs. oval shape, porous vs. non-porous, and with or without the use of a peg or motility post.

To put it simply, implant types can be divided into two main groups: non-integrated (non-porous) and integrated (porous).

Non-integrated (non-porous) implants

These implants do not allow for direct mechanical coupling with the ocular prosthesis. Also, they do not allow the in-growth of organic tissue into their structure.

Usually, they are covered with a synthetic cushioning material (polyester gauze) before placement.

This material allows fixation of the extraocular recti muscles and improves implant motility.

Non-integrated implants include acrylic or polymethyl methacrylate (PMMA ), glass, and silicone spheres.

PMMA has a high degree of compatibility with human tissue.

Integrated (porous) implants

Integrated implants allow fibrovascular ingrowth throughout their structure and insertion of pegs or posts.

Direct mechanical coupling improves artificial eye motility.

Porous implants currently are fabricated with natural and synthetic hydroxyapatite (HA), aluminum oxide, and polyethylene.

One main disadvantage of HA is that it needs to be covered with exogenous material, such as sclera, polyethylene terephthalate, or vicryl mesh, as direct suturing is not possible for muscle attachment.

However, the scleral covering has the risk of inflammation, infection, and rejection.

MEDPOR, on the other hand, is a high-density porous polyethylene implant, firm but malleable, that allows direct suturing of muscles without wrapping or extra steps.

Additionally, the smooth surface is less irritating and abrasive. It is cost-effective and can be easily modified or custom-fit in a personalized way.

Another option is prosthetics made of aluminum oxide. This ceramic biomaterial has been shown to be more biocompatible than HA.

Photo avant après - Prothèse oculaire 1A
Photo avant après - Prothèse oculaire 1B
Photo avant après - Prothèse oculaire 2A
Photo avant après - Prothèse oculaire 2B
Photo avant après - Prothèse oculaire 3A
Photo avant après - Prothèse oculaire 3B
Photo avant après - Prothèse oculaire 4A
Photo avant après - Prothèse oculaire 4B

Movement And Ocular Implants

The movement of the prosthetic eye depends on the type of implant the surgeon chooses.

Porous implants allow the surrounding ocular tissues, muscles, and blood vessels to grow into the implant.

When the eye muscles are properly attached to the porous implants, some of their movements are transferred to the overlying prosthetic eye, allowing the prosthesis to move.

In addition, inserting a peg into the implant allows to connect it with the back of the prosthesis, offering even more movement.

In some cases, this allows patients to track moving objects with the prosthetic eye in unison with their natural eye.

However, porous implants are more expensive and invasive, requiring wrapping and follow-up to determine vascularization and proper pegging for better transmission of implant movement.

Also, they could be more prone to implant exposure. So, it is better to discuss the best option for your particular case with your doctor.

Enucleation of Eye: The Procedure.

This surgery is normally performed under general anesthetic with a regular 2-night stay in hospital.

After your eye is removed, your doctor will use a round orbital/ocular implant that is inserted into the eye socket and later covered with eye tissue called conjunctiva.

Your doctor will attach the muscles that previously controlled your natural eye movement to the implant that will support your prosthetic eye.

Even though you won’t see with the prosthetic eye, suturing the muscles to the implant will allow you to move it in tandem with your other eye for a more natural look.

However, be aware that your prosthetic eye will not move as fully as your natural eye. Then, as part of your surgical procedure, you’ll receive a conformer or a temporary “shell” of clear plastic placed under your eyelid to help it keep its rounded shape.

This “placeholder” prevents the eye socket from contracting during the first few weeks after surgery.

The conformer will be replaced with a definite prosthetic eye between 6-10 weeks when you’ve fully healed from the procedure.

The prosthetic eye is a thin, curved, painted acrylic disk that looks just like a natural eye — including the iris, pupil, white, and even blood vessels —and is slipped onto the orbital implant. It can be removed, cleaned, and replaced when needed.

How Is The Recovery After Enucleation of Eye Surgery?

During surgery, the deep orbital implant placed in the eye socket results in a gentle stretching of tissues.

Patients are offered strong analgesics and proper medication because this can result in moderate pain, swelling, and nausea the first 72 hours after surgery.

The dressings are removed at home, and a check-up is scheduled two weeks later to remove the stitches that hold the lids together temporarily (a temporary suture tarsorrhaphy).

After that time, the clear shell fitted during surgery will be completely visible. It has a round hole in the middle, which assists with drainage and airflow and allows medications to be administered.

Usually, this is not alarming, although some patients prefer to wear dark glasses or a patch over the eyelids until the artificial eye is fitted.

Your doctor will show you how to clean the eye socket area and how to look after the shell.

To improve the healing process, it is advised to keep the area uncovered once at home.

However, patients can wear dark glasses until swelling has subsided.

Also, patients will receive eye drops or an ointment, which should be applied several times a day to prevent infection.

Once your eye surgeon has established that your socket is well healed, around 3-6 weeks after the surgery, you will be sent to have your custom artificial eye fitted (prosthesis).

Prosthetic Eye Aftercare

The ocular prosthetic should remain in the socket as long as possible, even during sleep (unless otherwise advised by your doctor). This ensures that the socket remains stable and healthy.

Don’t remove the acrylic prosthesis very often. Rinse any debris off your acrylic ocular prosthesis only when necessary.

You should remove your prosthetic eye every three weeks or once a month and wash it well with mild soap and water.

Afterward, dry it with a soft cloth before placing it back in your eye socket.

Other recommendations include:

  • Wash your hands carefully before handling the eye to prevent irritation or infection of the tissues in your eye socket.
  • Place your prosthetic eye into your eye socket using a plunger designed for this purpose.
  • Use lubricating eye drops over your acrylic prosthesis to relieve dryness and irritation
  • Get your prosthesis polished by your ocularist annually.

Although acrylic prosthetic eyes are very durable, you will have to replace your eye periodically.

Over time, your eye socket can change its size and affect the fit of your prosthesis, so you should have a replacement every 5-7 years.

Are There Any Risks And Side Effects?

Every surgery carries risks, and prosthetic eye surgery is no exception.

In rare instances, an uncommon kind of inflammation called sympathetic ophthalmitis can harm your healthy eye following evisceration surgery.

This happens because the exposed contents of the injured eye can trigger the body’s immune system against the tissues in the healthy eye.

This inflammation is mostly treatable and rarely leads to loss of sight in the good eye. Also, more eviscerations are now performed than enucleations to diminish this complication.

Additionally, there is always a risk of infection at the surgery site. However, infections are uncommon and easily treated using antibiotic drops or oral antibiotics.

Finally, once you begin wearing your prosthetic eye, you may experience temporary discomfort or tightness in your eye. But over time, you’ll grow used to the prosthesis.

ENUCLEATION OF EYE SURGERY SPECIALISTS:

Doctor Marta López Fortuny

Doctor Marta López Fortuny

Doctor Ainhoa Martínez Grau

Doctor Ainhoa Martínez Grau

External links – Bibliography

Custom-Made Ocular Prosthesis for Atrophic Anophthalmic Cavity. Costa MS, de Arruda JAA, Mesquita RA, Moreno A.J Craniofac Surg. 2018

Recommendations for post-adaption care of an ocular prosthesis: A review. Bonaque-González S, Amigó A, Rodríguez-Luna C.Cont Lens Anterior Eye. 2015

DO YOU WANT MORE INFORMATION ABOUT PROSTHETIC EYES?

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    Barraquer Ophthalmology Center Barcelona Spain Barraquer eye hospital Barcelona Spain

    Barraquer Eye Hospital

    Carrer de Muntaner, 314, 08021 Barcelona (Spain)

    Nearest Metro Stations:: Muntaner/ Gràcia