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SHORT COMMUNICATION  
Year : 2011  |  Volume : 22  |  Issue : 3  |  Page : 482-485
Restoration of an atrophic eye socket with custom made eye prosthesis, utilizing digital photography


Department of Prosthodontics, Govt. Dental College and Hospital, Aurangabad, Maharashtra, India

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Date of Submission15-Mar-2010
Date of Decision06-May-2010
Date of Acceptance08-Oct-2010
Date of Web Publication3-Nov-2011
 

   Abstract 

Ocular defects may cause several ocular and orbital disorders, which require surgical intervention. These defects are psychologically disturbing for the patients, and therefore, they require immediate management and rehabilitation by a team of specialist. Ocular prosthesis may be either readymade (stock) or custom made. Fabrication of a custom ocular prosthesis allows for a range of variations during construction. The iris can also be custom made by ocular painting or by digital photography. The optimum cosmetic and functional results of a custom-made prosthesis enhance the patient's rehabilitation to a normal life style. This paper elaborates the technique for fabrication of a custom-made ocular prosthesis for an atrophic eye socket utilizing digital photography.

Keywords: Digital photography, ocular prosthesis, stock eye shell

How to cite this article:
Jayaswal GP, Dange S P, Khalikar A N. Restoration of an atrophic eye socket with custom made eye prosthesis, utilizing digital photography. Indian J Dent Res 2011;22:482-5

How to cite this URL:
Jayaswal GP, Dange S P, Khalikar A N. Restoration of an atrophic eye socket with custom made eye prosthesis, utilizing digital photography. Indian J Dent Res [serial online] 2011 [cited 2019 Dec 13];22:482-5. Available from: http://www.ijdr.in/text.asp?2011/22/3/482/87076
The loss of a part of the face, particularly the eye, requires early replacement so that the patient may return to a normal life. The defect is distressing and both psychologic and economic difficulties exist. The combined efforts of an ophthalmologist and the maxillofacial prosthetist are needed to provide a satisfactory ocular prosthesis for such patients. The importance of an ocular prosthesis with acceptable esthetics and reasonable motility in restoring normal appearance in patients with anophthalmia has long been recognized, since ancient civilization. [1] At present times, three types of prosthesis are used; stock eyes, stock eyes modified by various methods, and custom-fitted eyes made from an impression of the socket This paper deals with a case report of a patient with atrophic eye socket restored with a custom made ocular prosthesis utilizing digital photography.


   Case Report Top


A 65-year-old male patient was referred to the Department of Prosthodontics from the Department of Ophthalmology for the replacement of his missing left eye. The patient gave history of evisceration of his left eye because of malignant melanoma 1 year previously. Patient was wearing a stock eye shell since 7 months with recurrent history of irritation, infection, and discharge. Medical history revealed presence of diabetes mellitus since 20 years and patient was under medication for the same. On examination, the socket was atrophied with limited amount of mobility. Cicatricial bands were absent and superior eyelid was depressed making deep supraorbital folds [Figure 1]. Concerning with the history of recurrent infection and severe atrophy of the socket, patient was selected for the custom-made ocular prosthesis.
Figure 1: Atrophic eye socket

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Impressions

The direct impression (external impression) technique was selected, in which low viscosity alginate or reversible hydrocolloid was injected directly into the enucleated socket. [2] Additional material was applied to the external tissue, and an impression was made using a rigid tray for reinforcement [Figure 2]. A two-piece dental stone mold was made around the impression.
Figure 2: Impression

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Wax conformer

Hard ivory inlay wax was poured into mold cavity through the opening left by the stem of the impression tray. [3] After removal of wax conformer, Undesirable irregularities and sharp ridges were eliminated and it was made smooth. Placing it in the socket, soft tissue contours around the wax conformer was compared with the natural eye and modified accordingly. The deep supraorbital folds were customized with an extra bulk on the wax conformer.

Duplication in sclera colored acrylic resin and sclera blank trial

After conventional flasking and dewaxing, flasks were packed with sclera colored methyl methacrylate resin. Curing was done at 212 o F water bath for 1 h. After curing, all irregularities of the sclera blank were removed and the scleral surface of the blank was polished. Polished blank was inserted into the socket and was examined. Discrepancies between right and left palpebral openings or in general contours were modified. After obtaining satisfactory shape, following Mcarthur's method center of pupil was marked with a red point. [4] The diameter of natural iris was measured which was 12 mm and it was replicated on the blank with the help of draftsman's compass taking the marked red point as the center of pupil [Figure 3]. The blank was reinserted and it was verified that the upper lid covers the top of the circle in the same manner and to the same extent as the opposite lid covers the iris. The blank was finalized according to the eye socket contours and lids configuration.
Figure 3: Marking the center of pupil

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Formation of iris

Digital photographs of patient's natural iris were made using a digital camera (Nikon D40 digital SLR Camera with attached closeup lenses 1, 2, 3. ASA 400, film sharpness 3008 × 2000 fine, Auto mode) [Figure 4]. Slight adjustment of color, brightness, contrast and intensity were made using graphic software (Adobe photoshop 7.0). [5] Final image was printed on 130 gsm white paper with differing brightness, contrast and intensity using a laser printer (Xerox digital copier 600 DPI laser printer with CREOFIERY) with a color ink cartridge. The iris diameter was decreased by 1 mm to compensate for the magnification caused due to the ocular button. Multiple prints were compared with the patient's natural iris for perfect color match and some best prints were selected. The ocular buttons were attached to the paper iris with the help of monopoly syrup. The obtained assemblies were matched with the patients natural iris and a best match was selected [Figure 5].
Figure 4: Digital photograph of natural iris

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Figure 5: The best match

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Final trial

With the help of sharp round scrapper, the marked spherical surface on the scleral blank was hollowed corresponding to the cornea of the natural eye, using the mean plane of the circle as a guide to the plane of the flat base. The artificial iris was attached to the base with the help of monopoly. Using the fine grained resin cutting stone, the surrounding surface was gradually reduced to the level of the top disk, leaving the recess about 0.5 mm deep. Remaining scleral surface was reduced from 1 to 2 mm, with the cut edges at a right angle to the posterior surface. The sclera was finally tried for iris color match, direction of gaze, scleral contours, and lids configuration and the necessary modifications were made.

Vein application

A red colored silk thread was teased to obtain its original fibers. A thin layer of monopoly was first applied on the scleral surface and over which the fibers were placed in the desired form.

Addition of transparent acrylic resin and completion of the prosthesis

A layer of 0.001 in. tinfoil was adapted to the top half of the retained flask. Clear methyl methacrylate resin was placed in the top half of the flask and was packed. Flask was placed in water bath of 212 o F to polymerize for 1 hour. The polymerized ocular prosthesis was finished and carefully polished to preserve all important form modifications [Figure 6].
Figure 6: Final prosthesis

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Patient's instructions

The patient was instructed to wear the prosthesis day and night. Pertaining to his history of recurrent infection and diabetes, he was advised to remove the prosthesis for cleaning once or twice a day for initial 15 days. In addition, he was prescribed antibiotics eye drops for 15 days and ophthalmic irrigation solution for further use. He was advised to consult an ophthalmologist for any feeling of irritation and infection.


   Discussion Top


The rehabilitation of a patient who has suffered the psychological trauma of an ocular loss requires a prosthesis that will provide the optimum cosmetic and functional result. Since every socket differs in size and shape, it is obvious that an individually designed prosthesis, is needed to provide maximum comfort and restore full physiologic function of the accessory organs of the eye.

Fabrication of a custom-made prosthesis allows infinite variations during construction.

As in the present case, the sagging upper eyelid was supported by an extra bulk superiorly on the sclera blank. The close adaptation to the tissue bed uses the full potential of the implant (if it is placed) to produce movement. Voids are minimized. The optimum cosmetic and functional result of a custom ocular prosthesis enhance the patient's rehabilitation to a normal life style.

The use of digital imaging in designing iris presents several advantages compared to the conventional oil paint and monopoly iris painting technique. The digital image provides acceptable esthetics result because it closely replicates the patient's iris with minimal color adjustments and modifications. The used technique is simple, decreases treatment time, and requires minimal artistic skills, which are necessary in the iris painting technique. However, special digital photography equipments and settings, as well as computer software that allow for image adjustment are required.


   Summary Top


Ocular prosthesis has a long history of successful use and variation of the techniques and the materials used have been introduced throughout the years. The method of fabricating custom ocular prosthesis utilizing digital photography has been described. Ocular prosthesis produced by this method are the most esthetic and comfortable possible and they could promote physical and psychological healing for the patient and improves social acceptance.

 
   References Top

1.Roberts AC. Facial prosthesis. 1 st ed. London: Henry Kimpton; 1971. p. 4.  Back to cited text no. 1
    
2.Mathews MF, Smith RM, Sutton AJ, Hudson R. The ocular impression: A review of the literature and presentation of an alternate technique. J Prosthodont 2000;9:210-6.  Back to cited text no. 2
[PUBMED]  [FULLTEXT]  
3.Cain JR. Custom ocular prosthetics. J Prosthet Dent 1982;48:690-4.  Back to cited text no. 3
[PUBMED]    
4.McArthur DR. Aids for positioning prosthetic eyes in orbital prosthesis. J Prosthet Dent 1977;37:320-6.  Back to cited text no. 4
[PUBMED]    
5.Artopoulou LL, Montgomery PC, Wesley PJ, Lemon JC. Digital imaging in the fabrication of ocular prosthesis. J Prosthet Dent 2006;95:325-30.  Back to cited text no. 5
    

Top
Correspondence Address:
Gaurav P Jayaswal
Department of Prosthodontics, Govt. Dental College and Hospital, Aurangabad, Maharashtra
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0970-9290.87076

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    Figures

  [Figure 1], [Figure 2], [Figure 3], [Figure 4], [Figure 5], [Figure 6]

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