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SHORT COMMUNICATION  
Year : 2010  |  Volume : 21  |  Issue : 4  |  Page : 615-617
A simplified approach to fabrication of an ocular prosthesis: A case series


Department of Prosthodontics, Faculty of Dental Sciences, C.S.M. Medical University, Lucknow, India

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Date of Submission18-Nov-2009
Date of Decision19-Mar-2010
Date of Acceptance21-May-2010
Date of Web Publication24-Dec-2010
 

   Abstract 

The eye is a vital organ and an important component of facial expression. Loss of an eye has a crippling effect on the psychology of the patient. Enucleation of the eye is therefore normally followed by fabrication of an ocular prosthesis to improve esthetics. A less complex technique for fabrication of an ocular prosthesis is described in this report of two different cases.

Keywords: Custom ocular prosthesis, enucleation, opthalmic alginate

How to cite this article:
Kaur A, Pavaiya A, Singh SV, Singh RD, Chand P. A simplified approach to fabrication of an ocular prosthesis: A case series. Indian J Dent Res 2010;21:615-7

How to cite this URL:
Kaur A, Pavaiya A, Singh SV, Singh RD, Chand P. A simplified approach to fabrication of an ocular prosthesis: A case series. Indian J Dent Res [serial online] 2010 [cited 2020 Apr 2];21:615-7. Available from: http://www.ijdr.in/text.asp?2010/21/4/615/74236
Surgical procedures in the removal of an eye can be broadly classified as: evisceration (where the contents of the globe are removed leaving the sclera intact), enucleation (most common, where the entire eyeball is removed after severing the muscles and the optic nerve) and exenteration (where the entire contents of the orbit including the eyelids and the surrounding tissues are removed). Treatment of such cases requires fabrication of an ocular prosthesis to restore a more normal facial appearance. [1],[2],[3]

The purpose of this case report is to document a simpler technique for the fabrication of ocular prosthesis that does not depend much on artistic ability of the operator and is relatively easy to be performed by a dentist along with saving on laboratory time.


   Case Reports Top


Case 1

A four-year-old male child reported to the Department of Ophthalmology with complaints of white spot on the right eye accompanied by bulging and squint, and pain on movements, as narrated by his father. He was diagnosed with retinoblastoma and an enucleation surgery was performed. The patient was referred to the Department of Prosthodontics for the fabrication of an ocular prosthesis after healing [Figure 1]a.
Figure 1: Pre-rehabilitation view

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Case 2

A 38-year-old female reported to the Department of Ophthalmology of the institute with complaints of constant headache, loss of vision, suppuration and bulging of left eye. After thorough investigations including CT scan and FNAC, the patient was diagnosed with malignant melanoma of the left eye. The eye was subsequently enucleated and on healing of the socket, the patient was referred to the Department of Prosthodontics for fabrication of ocular prosthesis [Figure 1]b.

clinical procedure

After careful examination of the area of the defect and treatment planning, the procedure was explained to the patient/guardian to gain their co-operation. Patient/guardian consent was taken for making photographic records. The procedure was initiated by selecting and modifying a pre-fabricated (stock) eye, whose iris and pupil closely matched that of the natural eye, to comfortably and loosely fit the socket. This was duplicated with clear-heat cured PMMA (Trevalon, Dentsply India Pvt. Ltd., Gurgaon, India) and perforated for use as a tray in the impression procedure.

Perforation of the tray was done to avoid any compression of the ocular tissues. The tray was placed in the socket and the patient was asked to gaze at a distant point to accurately mark the pupil as per contralateral side, on the tray.

First, petroleum jelly was applied to the eyebrows for the easy removal of the impression when it sets. A thin tube (1 mm diameter and 2 cm length) was fabricated to serve as a handle for the impression tray and attached at the pupillary point for proper tray orientation during impression making [Figure 2]. A thin mix of ophthalmic alginate (Opthalmic moldite, Milton Roy Co. Sarasota Fla.) was then injected in the socket and loaded on the tray, which was placed into position. [4] The patient was asked to move his/her normal eye in all directions to allow the alginate to flow into all areas of the enucleated socket, as well as onto the tray's outer surface to record lid movements, while taking care that the tray handle replicated the pupillary position of the natural eye. Impression was examined for accuracy [Figure 3] and the cast was poured in two parts with the second part being poured after applying lubricant and making orientation grooves on the partially set first half [Figure 4]. The tube was maintained as a sprue to pour the wax pattern and to transfer the pupillary point onto the cast.
Figure 2: Impression tray with tube in position

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Figure 3: Impression in ophthalmic alginate

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Figure 4: Cast poured in two separate portions

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The technique was modified here onwards by orienting the previously mentioned stock eye on the cast according to previously transferred pupillary mark. Liquified modeling wax was then poured into the cast, taking care that the stock eye was maintained in its previously oriented position, in the wax pattern. This stock eye-wax pattern combination was tested in the socket and modified for adequacy of ocular movements, correction of pupillary alignment, proper palpebral movements, scleral contour and convexity. The next step was to reproduce scleral shade of the normal eye. For this, shade tabs were prepared by mixing and matching different shades and proportions of tooth-colored acrylic (SC 10, Pyrax, Roorkee, India) till the color of sclera of the other eye was replicated. Then the adjusted and modified stock eye-wax pattern combination was invested, flasked and de-waxing was done. Red silk fibers to mimic veins were placed in the dough of the determined acrylic shade followed by routine curing, finishing and polishing. Finally, a thin film of the sclera was removed and replaced by a clear film of transparent heat-cured PMMA (Trevalon, Dentsply India Pvt. Ltd., Gurgaon, India) to simulate corneal translucency. The properly finished and polished prosthesis was inserted in the socket after being disinfected and lubricated with an ophthalmic lubricant (Ecotears, Intas Pharmaceuticals Ltd, Ahmedabad, India) to maintain a tear film over the prosthesis and to improve eye movements. Minor adjustments were made at the time of delivery as per the patient's comfort and esthetics [Figure 5]a and b. Necessary instructions for cleaning, placement and removal of the prosthesis were given and the need for regular recall appointments was emphasized. [5]
Figure 5: Post-rehabilitation view

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   Discussion Top


Two options are available for artificial eye prosthesis, one is a pre-fabricated ocular prosthesis and the other is custom-made. Pre-fabricated prosthesis carries potential disadvantages of poor fit (which endangers the eye to granuloma formation), poor esthetics and poor eye movements. [5] Custom-made prosthetic eye fabrication involves complex painting procedures in various stages that are quite difficult and based purely on painting skills of the operator. [4] The technique to fabricate ocular prosthesis in these case reports, modifies a pre-fabricated eye prosthesis to a custom-made fit and esthetics. This helped us to overcome the disadvantages of poor fit, esthetics and movement of a prefabricated prosthesis and complex painting procedure and technique involved in making a custom-made ocular prosthesis.

This technique would also be relatively easy to perform, along with saving on laboratory time. The close adaptation of the custom-made ocular prosthesis to the tissue bed provides maximum comfort and restores full physiologic function to the accessory organs of the eye. Voids that collect mucus and debris, which can irritate the mucosa and act as a potential source of infection may also be minimized. [3]

Limitations of the technique are that the clinician is dependent on the availability of a pre-fabricated eye with properly matching iris and pupillary part. Also, the long-term color stability of the heat-cured acrylic and the strength of its union with the stock eye will have to be closely evaluated.

 
   References Top

1.Parr GR, Goldman BM, Rahn AO. Surgical considerations in the prosthetic treatment of ocular and orbital defects. J Prosthet Dent 1983;49:379-85.  Back to cited text no. 1
[PUBMED]    
2.Bartlett SO, Moore DJ. Ocular prosthesis: A physiologic system. J Prosthet Dent 1973;29:450-9.  Back to cited text no. 2
[PUBMED]    
3.Murphy PJ, Schlossberg L. Eye replacement by acrylic maxillofacial prosthesis. Naval Med Bull 1944;43:1085.  Back to cited text no. 3
    
4.Allen L, Webster HE. Modified impression method of artificial eye fitting. Am J Ophthalmol 1969;67:189-218.  Back to cited text no. 4
[PUBMED]    
5.Cain JR. Custom ocular prosthesis. J Prosthet Dent 1982;48:690-4.  Back to cited text no. 5
[PUBMED]    

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Correspondence Address:
Amandeep Kaur
Department of Prosthodontics, Faculty of Dental Sciences, C.S.M. Medical University, Lucknow
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0970-9290.74236

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    Figures

  [Figure 1], [Figure 2], [Figure 3], [Figure 4], [Figure 5]

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2 Effect of Oil Paint Addition on Impact Strength of the Scleral Part of the Acrylic Ocular Prosthesis
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