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Table of Contents   
SHORT COMMUNICATION  
Year : 2011  |  Volume : 22  |  Issue : 5  |  Page : 716-718
An innovative technique for customizing the stock acrylic resin ocular prosthesis


1 Department of Prosthodontics, V. S. P. M. Dental College and Research Center, Nagpur, India
2 Professor, Department of Prosthodontics, Government Dental College and Hospital, Aurangabad, India

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Date of Submission05-Feb-2010
Date of Decision27-Aug-2010
Date of Acceptance27-Jun-2011
Date of Web Publication7-Mar-2012
 

   Abstract 

The loss of an eye is a traumatic and common event. The psychological effects of losing an eye are frequently more difficult to deal with than its functional loss. This article describes the management of a child patient with anopthalmic socket, by an innovative technique of customizing the stock acrylic resin ocular prosthesis to get improved esthetics, accurate location of iris-pupil complex and exact fit in the defect.

Keywords: Customizing, ocular prosthesis, stock acrylic resin

How to cite this article:
Mowade TK, Dange S P. An innovative technique for customizing the stock acrylic resin ocular prosthesis. Indian J Dent Res 2011;22:716-8

How to cite this URL:
Mowade TK, Dange S P. An innovative technique for customizing the stock acrylic resin ocular prosthesis. Indian J Dent Res [serial online] 2011 [cited 2014 Oct 20];22:716-8. Available from: http://www.ijdr.in/text.asp?2011/22/5/716/93463
"A person with facial disfigurement at the sight of whom all men turn in disgust and abhorrence and at whose presence children cry and dogs bark" -

Dieffenbach (German Surgeon). [1]

Despite the tremendous advances in social, medical, surgical and prosthetic rehabilitation over the last 100 years, the plight of those with facial disfigurement unfortunately has not changed greatly since the statement was made. The loss of an eye is a traumatic event. However, effect of this loss on the patient's remaining visual capacity is not substantial. The psychological effects of losing an eye, however, are frequently more difficult to deal with. A child patient with anopthalmic socket cannot express in his words the agony, when his fellow friends do not play with him. It is the duty of prosthodontist to rehabilitate the social stigma of this patient. This article describes a technique of fabricating the ocular prosthesis by using a stock eye.


   Case Report Top


A 4-year-old male patient was referred to the Department of Prosthodontics, Government Dental College and Hospital, Aurangabad, from Ophthalmology Department of Government Medical College and Hospital for prosthetic rehabilitation of left ocular defect. On history taking, it was found that patient was suffering from retinoblastoma of left eye and the eye had to be enucleated. On examination, it was found that the mucosa surrounding the eye was healthy without any infection and the post-surgical healing was complete [Figure 1]. It was decided to give the ocular prosthesis by modifying the stock eye prosthesis.
Figure 1: Preoperative photograph

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Procedure

Step I: Ocular impression

2% Lignocaine hydrochloride topical gel was applied on the tissues of the left eye before making an impression, to reduce the irritability of mucosa while making the impression.

An impression technique developed by Allen and Webster uses an impression tray in the shape of an ocular prosthesis. [2]

A modified impression tray was fabricated using the hollow needle cover. The closed end of the needle cover was opened by trimming on the lathe, and autopolymerizing acrylic resin bulb was made at the other end for retention of the impression material. This impression tray was placed within the socket to support the eyelids and provide a more normal contour.

Once the tray was placed in position, the patient was instructed to pie his seeing eye on a target that placed the eye in a straight ahead gaze.

The irreversible hydrocolloid impression material was mixed using an extra half measure of warm water to form a smooth, runny mix that would set quickly.

The impression material was then transferred to a syringe and injected into the socket through the hollow needle cover. Once the impression material was set, the patient was instructed to look up as the prosthodontist retracted the lower lid and drew the stem of the tray upward, allowing the air to enter behind the impression.

The impression was released from the lower fornix. The patient was then instructed to look down and the tray was removed from the superior fornix while applying some pressure against the upper lid.

The impression was then removed and invested in two-piece mold to form a wax pattern [Figure 2].
Figure 2: Impression of the defect

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Step II: Fabrication of custom-fitted ocular prosthesis [3],[4],[5],[6],[7]

The stone mold was lubricated with petrolatum oil and modeling wax was poured to prepare the wax pattern. The wax pattern was tried in the ocular defect, its support to the upper eyelid was verified and various eye movements were checked for stability of the pattern. This pattern formed the base for the stock acrylic resin ocular shell.

The position of the iris-pupil complex was marked on the pattern by using contralateral iris pupil as a guide when the patient's eye was in a straight ahead gaze. The pattern was removed and placed back in the stone mold. Position of the iris-pupil complex was transferred on the stone mold by marking the vertical lines passing tangent to the marked position of the iris-pupil complex [Figure 3].
Figure 3: Position of pupil recorded on the wax pattern and transferred on the stone mold

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A suitable stock acrylic resin ocular prosthesis with the dimensions and color of the iris-pupil complex and sclera closely resembling the patient's contralateral eye was selected. The stock ocular prosthesis was modified by trimming its periphery to fit the eye socket using stone mold as a guide for maintaining the relation of iris-pupil complex to the periphery.

Inner surface of the ocular shell was grooved so that it could be attached to the wax pattern, paying extra attention to central iris-pupil corneal area when the adjustments were made. The ocular shell was attached to the wax pattern and verified in the stone mold for location of the iris-pupil complex [Figure 4].
Figure 4: Stock ocular prosthesis attached to wax pattern

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The wax pattern with eye shell was then tried in the patient's socket. It was seen that it matched with the normal eye of the patient at least 2 feet away, with the patient sitting upright. Several eye movements were made to perform and the comfort of patient was checked.

When the adaptation and esthetics were satisfactory, the ocular prosthesis was processed for the conversion of modeling wax into heat-cured acrylic resin to complete the ocular prosthesis [Figure 5].
Figure 5: Completed ocular prosthesis

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Step III: Prosthesis delivery and patient instructions

The customized acrylic resin ocular prosthesis was delivered to the patient after checking comfort and esthetics of prosthesis [Figure 6]. Patient was allowed to use the prosthesis for 48 hours. In the recall after 48 hours, orientation, comfort, hygiene and tissue health were reevaluated. The patient was instructed to wear the prosthesis day and night. It needed to be removed from the socket and washed with mild soap once in every 1 or 2 weeks. Daily ocular hygiene was advised using the ophthalmic irrigation solution as eye drops. The patient was taught the method of removal and replacement of the prosthesis before he was allowed to leave the office with the prosthesis.
Figure 6: Prosthesis in position (postoperative view)

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   Discussion Top


Ocular prosthesis is an artificial replacement for the bulb of the eye. The age at which the patient becomes anopthalmic also plays a role in prosthetic management. As the patient's (presented here) eye was removed at a young age, his orbits might not have finished growing. When a globe is removed, normal orbital growth is retarded and the face may become malformed. Therefore, prosthesis should be made slightly larger to simulate normal development of the surrounding tissues. It was advised to remake the prosthesis at intervals to keep pace with growth till the eye socket is fully developed at around 12 years of age.

The technique described for customizing the stock ocular prosthesis is simpler and gives more accuracy in locating the iris-pupil complex, improved esthetics and exact fit in the socket.


   Conclusion Top


Rehabilitation of anopthalmic child patient is challenging as it needs long-term prosthetic follow-up till the growth of anopthalmic socket is complete at around 12 years of age. There is also a need of providing psychological support to the patient. A simple and effective method of customizing the stock ocular prosthesis has been described.

 
   References Top

1.McKinstry RE. Fundamentals of facial prosthetics. Arlington, USA: ABI Professional Publications; 1995. p. 99-120.   Back to cited text no. 1
    
2.Walden RB, Niiranen JV. Ocular prosthesis. J Prosthet Dent 1956;6:272-8.  Back to cited text no. 2
    
3.Cain JR. Custom Ocular Prosthetics. J Prosthet Dent 1982;48:690-4.  Back to cited text no. 3
[PUBMED]    
4.Allen L, Webster HE. Modified impression method of artificial eye fittings. Am J Ophthalmol 1969;67:189.  Back to cited text no. 4
[PUBMED]    
5.Taicher S, Steinberge HM, Tubiana I. Modified stock ocular prosthesis. J Prosthet Dent 1985;54:95-8.  Back to cited text no. 5
    
6.Beumer J, Curtis TA, Marunick MT. Maxillofacial rehabilitation prosthodontic and surgical considerations. St Louis: The CV Mosby Co.; 1996. p. 424-30.  Back to cited text no. 6
    
7.Dixit S, Shetty P, Bhat GS. Ocular prosthesis in children: Clinical report. Kathmandu Univ Med J 2005;3:81-3.  Back to cited text no. 7
    

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Correspondence Address:
Tushar K Mowade
Department of Prosthodontics, V. S. P. M. Dental College and Research Center, Nagpur
India
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DOI: 10.4103/0970-9290.93463

PMID: 22406720

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    Figures

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



 

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    Abstract
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   Discussion
   Conclusion
    References
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