Contact Lens & Anterior Eye 30 (2007) 152162

www.elsevier.com/locate/clae

Review

Ocular prosthesis
Kuldeep Raizada *, Deepa Rani
Department of Ocularistry, LV Prasad Marg, LV Prasad Eye Institute, Banjara Hills, Road No. 2, Hyderabad 500 034, Andhra Pradesh, India

Abstract
Loss of an eye or a disfigured eye has a far-reaching impact on an individuals psyche. Additionally it affects ones social and professional
life. Cosmetic rehabilitation with custom made prosthetic devices gives such individuals professional and social acceptance and alleviates
problems. This article aims at enhance awareness of the cosmetic benefits of custom designed ocular prosthesis. Ocularistry, the science of
making ocular prosthesis, has undergone phenomenal growth in recent times. Ocularistry is fast evolving in India. Ocularist is the skilled
individual involved in fabricating the ocular prosthesis.
# 2007 British Contact Lens Association. Published by Elsevier Ltd. All rights reserved.
Keywords: Ocular prosthesis; Congenital deformities; Anophthalmia; Microphthalmia; Acquired deformities; Phthisis bulbi; Atrophic bulbi; Staphyloma;
Post-evisceration; Post-enucleation; Post-orbital exenteration

Contents
1.
2.
3.
4.
5.
6.
7.
8.
9.
10.
11.
12.
13.
14.
15.
16.
17.
18.
19.
20.

Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
History . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Psychological prospect of ocular disfigurement . . . . . . .
Indications for prosthetic devices . . . . . . . . . . . . . . . . .
Types of prosthesis . . . . . . . . . . . . . . . . . . . . . . . . . .
Prosthetic contact lens . . . . . . . . . . . . . . . . . . . . . . . .
Scleral shell versus full thickness ocular prosthesis . . . .
Orbital prosthesis . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Material used in prosthetic devices . . . . . . . . . . . . . . .
Method of fabrication of custom made ocular prosthesis.
Ideal prosthesis . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Ideal socket. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Prerequisites for a good prosthetic fitting . . . . . . . . . . .
Important consideration . . . . . . . . . . . . . . . . . . . . . . .
Custom versus stock prosthesis . . . . . . . . . . . . . . . . . .
Advances in ocular prosthesis . . . . . . . . . . . . . . . . . . .
Care for the ocular prosthesis, eyelids and eye socket . .
17.1. Daily routine . . . . . . . . . . . . . . . . . . . . . . . . . .
Surface cleaning of the prosthesis and eyelids . . . . . . . .
Consulting the ocularist . . . . . . . . . . . . . . . . . . . . . . .
Consulting the ophthalmologist . . . . . . . . . . . . . . . . . .
References . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

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* Tel.: +91 40 30612332; fax: +91 40 23548271.

E-mail addresses: ocularist@gmail.com, ocularist@lvpei.org (K. Raizada).
URL: www.lvpei.org
1367-0484/$ see front matter # 2007 British Contact Lens Association. Published by Elsevier Ltd. All rights reserved.
doi:10.1016/j.clae.2007.01.002

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K. Raizada, D. Rani / Contact Lens & Anterior Eye 30 (2007) 152162

153

1. Introduction

3. Psychological prospect of ocular disfigurement

Loss of an eye or a disfigured eye has a far-reaching

impact on an individuals psyche. Additionally it affects
ones social and professional life. Cosmetic rehabilitation
with custom made prosthetic devices gives such individuals
professional and social acceptance and alleviates problems.
This article aims at enhance awareness of the cosmetic
benefits of custom designed ocular prosthesis.
Ocularistry, the science of making ocular prosthesis, has
undergone phenomenal growth in recent times. Ocularistry
is fast evolving in India. Ocularist is the skilled individual
involved in fabricating the ocular prosthesis.

The main problem arises once you have some of the

person in your community, people look the person with lot of
sympathy, most of the people does not like, and keeping the
hope that some day some new technology may come and
they can get rid of the ocular disfigurement and see with that
eye.
Very often it has been founded even the well educated
patient also stressed with the ocular disfigurement, reason
lack of self-confidence and fear of the person comments
and sympathy and that is why keep on visiting the various
clinic in India and over seas but when they do not find any
hope to restore the vision, they usually get frustrated and
like to be isolated from the community and we loose the
great people who can be some thing very great and human
well wisher.
By fortune now as we are located the ocularistry services
in tertiary eye care centre, a lot of different kind of patient
they come and visit the services and opt for ocular
prosthesis, we have got a very positive feed back that
patient feel back once the prosthesis work done for them like
to face new world with a new face.

2. History
It is believed that the first artificial eyes were made by
Egyptians. The Babylonian and Sumerian civilizations had
probably used art-eyes in mummies and statues, made
from precious stone, silver or gold [13]. Pare from Paris
published a book in 1561 which describes two types of
ocular prosthesisone fitted underneath the eyelids called
hyplepharon and the other fitted externally called
eclepharon [4]. In the beginning of the 19th century,
France became the centre of artificial eye making.
Boissoneau in 1849 was credited with coining the term
ocularist [5]. He produced stock glass eyes, which were
popular in Europe and America. In 1853, Ludwig Muller Uri
used a new material and method for making human glass
eyes [6]. His doll eyes were breathtakingly life-like [7]. He
developed a unique method of colouring the iris. His
nephew, Friedrich A. Muller is credited with developing the
double wall glass prosthesis [7]. Most of the commonly
known ocular prostheses had been developed by the end of
the last century. Peter Gouglemann, a student of Boissoneau
had set up a studio of ocular prosthesis in 1851, in New York
[5]. During the Second World War, shortage of glass
material led to the usage of a dental acrylic, methyl
methacrylate (MMA). The first international organization in
ocularistry was the American Society of Ocularists which
came into being on 13 October 1958. Rapid advances have
been made over the last five decades in the technique and
materials used in making ocular prosthesis. In India the art of
fabricating the ocular prosthesis had been started at the same
time as any where else in the world, in 1954, India had the
1st ocularistry services in a very small town in the Eastern
part of the country, but this art was limited to the practice of
the family one and did not spread any where else in the
country, other people either has to send a patient or to be
relied on the ready made prosthesis, both of them were not
very successful, after about five decades in India we have
started with the very basic technology in 2002 and have
updated our laboratory to an advanced one with all kind of
ocular prosthesis facility, so far we have helped more than
6000 patients across the globe.

4. Indications for prosthetic devices

The various indications requiring prosthetic devices are
divided into two broad categories namely congenital and
acquired deformities.
A. Congenital deformities (Fig. 1ac, and f)
 Anophthalmia
 Microphthalmia
B. Acquired deformities (Fig. 2ap)
 Phthisis bulbi
 Atrophic bulbi
 Staphyloma
 Post-evisceration
 Post-enucleation
 Post-chemical injuries
 Contracted socket following radiation
 Post-orbital exenteration

5. Types of prosthesis
Prosthesis means an artificial device used to replace a
missing body part [4]. The prosthesis used to improve the
cosmesis in the orbital region can be broadly classified as
ocular and orbital prosthesis. Ocular prosthesis can be
further classified into stock and custom prosthesis with the
latter referring to tailor made prostheses.
1. Ocular
 Prosthetic contact lens

154

K. Raizada, D. Rani / Contact Lens & Anterior Eye 30 (2007) 152162

Fig. 1. (a, b and f) Congenital microphthalmos; (c) Goldenhar syndrome; (d and e) phthisis bulbi.

Fig. 2. (ac and o) Traumatic deformities of the orbit and periorbital tissues; (d) atrophic globe with exotropia; (e) anophthalmic sockets with deep superior
sulcus; (f) contracted socket with lower shallow fornix; (g) severe contracted anophthalmic socket following external beam radiation therapy (EBRT); (h) case
of lid sparing orbital exenteration for ocular malignancies extended to the orbit; (i) severe ankyoloblepharon following chemical injury; (j) atrophic globe with
multiple symblepharons in the cavity; (k) severe contraction of socket with chemical injury; (l) case of severe orbital deformity following the occurrence of
rhabdomyosarcoma and treatment with radiation and subsequently trail of constructing the lids; (m) severe superior migrated implant resultant in the complete
ptosis; (n) case of severe ocular surface contraction for retinoblstoma and treatment with radiation; (p) left eye anterior staphyloma.

K. Raizada, D. Rani / Contact Lens & Anterior Eye 30 (2007) 152162

 Scleral shell
 Full thickness prosthesis
2. Orbita
 Partial
 Complete
 Spectacle mounted prosthesis
 Adhesive retained prosthesis
 Magnetic retained prosthesis

6. Prosthetic contact lens

Prosthesis contact lenses are fitted over the scarred
corneas with partial/total discolouration of cornea. A wide
variety of soft and semi-soft contact lenses are available for
cosmetic application.

155

8. Orbital prosthesis
Orbital prosthesis is indicated in conditions where
there is additional loss of periocular tissues like eyelids,
eyelashes and eyebrows. While fabricating an orbital
prosthesis utmost care is taken to not only replace lost
periocular tissue but match them in terms of colour and
texture to the fellow orbit (Fig. 3). However in this
paper we are focused entirely on all aspect of ocular
prosthesis, we will not be discussing much on orbital
prosthesis.

9. Material used in prosthetic devices

 Glass
 Poly methyl methacrylate (PMMA)
 Silicon

7. Scleral shell versus full thickness ocular prosthesis

The bases of differentiating a scleral shell from a full
thickness ocular prosthesis vary in the literature. According
to one school of thought, scleral shell is any prosthesis with a
thickness measuring less than 1.5 mm. A full thickness
ocular prosthesis measures more than 1.5 mm in thickness.
However according to the world dictionary of ophthalmic
prosthesis by Kelly et al. a scleral shell defined as any ocular
prosthetic device fitted over a residual globe like phthisis
bulbi, atrophic bulbi or microphthalmos [1113]. A full
thickness ocular prosthesis is fitted in an orbit with no
residual globe.

Glass was once the preferred prosthetic material, but

owing to difficulty in moulding and its fragile nature it is
seldom used today. However glass eyes are still fabricated in
some parts of the Europe. Modern ocular prosthesis are
fabricated using poly methyl methacrylate (PMMA) [28].
Ease of moulding into any desired shape and its intrinsically
inert nature make it the material of choice in fabricating
ocular prosthesis.
Silicon is the material of choice in fabricating the orbital
prosthesis with the periocular skin and pattern. It is nonreactive, moulds easily and above all the desired skin texture
can be created over the surface.

Fig. 3. (a) A case of squamous cell carcinoma in right eye with orbital extension post-lid sparing orbital exenteration; (b) cosmetic outcome following
rehabilitation with a total orbital prosthesis with periocular skin, eye lashes and eye brow; (c) total orbital prosthesis; (d) partial orbital prosthesis.

156

K. Raizada, D. Rani / Contact Lens & Anterior Eye 30 (2007) 152162

10. Method of fabrication of custom made ocular

prosthesis
The procedure of fabrication involves the following steps
1.
2.
3.
4.
5.
6.
7.
8.
9.
10.

Examination by the ocularist

Taking an impression
Wax model for the socket
Centration of the prosthesis
Fabrication of iris and pupil to match the fellow eye
Moulding in acrylic
Tinting to match the scleral shade
Packing with the clear acrylic
Polishing
Instructions about hygiene and care of the prosthesis

10.1.1. Preparation of the patient

The patient should be reassured that taking an impression
is less uncomfortable than the insertion of a trial prosthesis
shell. The patient must keep the contralateral normal eye
open and fixate on a predetermined point straight ahead.
10.1.2. Taking an impression
With the patient sitting on a chair and looking the head
up with primary gaze, makes the impression much easier,
topical anaesthetic is instilled and the moulding material

is prepared with a spatula in a rubber bowl. The mixture is

placed in the syringe with the help of a flat spatula.
While placing the moulding shell (also called as impression tray) on the eye, the patient is instructed to with the
eye in down gaze the upper lid is retracted and the shell is
first inserted underneath the upper eyelid followed by the
lower eyelid. Both eyes fixed in primary gaze the syringe
is attached to the shell and moulding material injected
gently. The moulding mixture gels in about 2 min. The
gelled mixture has the consistency of a hard-boiled egg
(Fig. 4ac).
10.1.3. Removing the impression
The upper and lower eyelids are gently retracted and the
shell handle is drawn towards the eyebrows along with a
side-to-side rocking motion, which allows release. After the
removal the shell is immersed in water.
10.1.4. Moulding the impression into the wax model
Half a cup of distilled water is taken and mixed
thoroughly with the one spoonful of alginate. This paste is
then poured in a plastic cup and the rear surface of
impression. The alginate hardens in about 23 min. The
alginate mould is cut along the lines drawn on the impression
tray. The carving wax is heated in a steel bowl till it becomes
liquid. The molten wax is poured into the alginate mould and

Fig. 4. (a) Material used in taking impression of the cavity, impression material, impression tray, spatula, syringe taking by using hydrophilic colloid; (b) patient
fixates contralateral hand; (c) close-up of the impression cavity; (d) impression cavity of left eye; (e) the lateral marking on the stem, help in making decision of
the centre of the pupil; (f) making of alginate mold; (g) carving wax used for replicating the wax model; (h) alginate molds cut in to four partial sections and
impression has been taken out; (i) carving wax is being melt with gas torch; (j) hot wax is poured in the alginate mold cavity and allows it to cool at room
temperature, once wax is set it can be taken out from the alginate mold; (k) wax shape is achieved; (l) different types of iris button (metal, colour, painted or clear
corneal button), and stem that can be used for locating the angle of iris and pupil; (m) left eye wax model in situ with centre of pupil using acrylic stem.

K. Raizada, D. Rani / Contact Lens & Anterior Eye 30 (2007) 152162

allowed to harden. An exact replica of the socket impression

is now created (Fig. 4dj).
10.1.5. Centration of the iris
Centration of the iris and marking the corneal plane is
essential to achieve symmetry of the two eyes. Various
methods used to achieve symmetry are:
1. Using the interpupillary distance (IPD). Once the wax
model has been made, wax solvent is used to smooth the
surface. This wax model is inserted in the patients
socket. After making it symmetrical with respect to its
position and plane, the interpupillary distance is marked
with a non-toxic marker.
2. Using Hirschbergs test. In absence of gross asymmetry
of the orbit and plane, the base for the ocular prosthesis
can be made in white acrylic and inserted into the socket.
The light reflex is kept at the centre of the model.
3. Inscribing a circle. On the white acrylic base, based on
the ocularists judgment a circle is inscribed in the centre
corresponding to the fellow eye.
4. Using iris corneal buttons. This is the most difficult of the
various methods described above. However this gives the
best cosmetic result. The iris button is inserted in the wax

157

model using the carving wax and hot metal spatula and
symmetries by trial and error (Fig. 4j and k).
Once the wax model is finished, a two-piece mould in the
dental stone is prepared. Making 1st front surface and later
pour the dental stone in the second half (Fig. 5ad). The
white base of the poly methyl methacrylate (PMMA) is
poured into the moulds and cured at 110 8C temperature and
at 4 bar pressure (Fig. 5ej). Once cured taken out from the
mould and trim the edges, polished (Fig. 6ae) and inserted
into the patients socket. While doing so we reconfirm the
size, plane and angle of the iris in the white base. If
satisfactory symmetry and cosmesis is visualized, exposed
the corneal button (Fig. 6f) and the process of tinting is
begun. Cotton rayon threads are used to give the appearance
of blood vessel appearance (Fig. 6g). Dry stable natural fine
grinded colour pigments are used to give the exact shade to
the sclera corresponding to the patients fellow eye. Once it
is ensured that the exact colour matching has been achieved
(Fig. 6h), the base of the prosthesis is kept in the oven at
85 8C for 30 min. This cures the colours to saturation levels
and prevents any future fading. Once the artwork is
completed, the shell is put back into mould and a layer of
clear plastic is polymerized on the front surface, completing
the fabrication process (Fig. 6i). After trimming and

Fig. 5. (a) Using the dental grade two plaster is mixed with slurry (fine mixture of Plaster of Paris with water), invest the wax mold stem straight a head, in the
centre of metal mold; (b) apply the cold sap (create a thin film) in order when the other part of the mold is made should not stick together; (c) close the other face
of the mold; (d) pour the dental stone on the hole of the mold on a vibrator so that all the possible air bubble will come out and a smooth bubble free mold can be
achieved. Once plaster is set mold can be open and wax model can be taken out; (e) white duff of the PMMA be placed on the iris corneal unit to achieve a nice
limbus blend; (f) enough duff of PMMA placed on the back of the button; (g) on the back surface of the mold we use dental dam (from Hygine, USA), which will
provide the smooth back surface, very useful in the undercut back surface where polishing is very difficult; (h) once you press excessive material is comes out
and can be taken off; (i) mold will be placed in the metal clamp to give adequate pressure; (j) curing takes place with polymerising unit at 110 8C temperature and
4 bar pressure.

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Fig. 6. (a) Once the PMMA get cures it taken out from the mold with the releasing the pressure; (b) shape is taken out from the mold; (c) edges are trimmed and
polished with the buffing wheels; (d) center of the iris is exposed with the round stone burr of desired size, usually 0.5 mm less than the actual, as it is going to
magnify; (e) shape is mounted on a wax base; (f) using the cotton rayon thread to create the blood vessels; (g) places the thread fibers on the base as per the fellow
eye; (h) fabrication of scleral shade using the dry stable earth pigment with the monopoly solution (a mixture of monomer and polymer), achieved with various
colours till the exact shade and hue is matched; (i) laminated with clear layer of PMMA; (j) edges are trimmed and polished with the buffing wheels.

polishing, the final prosthesis (Fig. 6j) may need minor

adjustments such as adding or removal of PMMA in
different places may be needed for opening or closing the
lids, correction of ptosis, ectropion and cicatricial bands.
It will than be further evaluated for





Comfort
Stabilization
Vertical and horizontal position
Motility








Iris and sclera colour

Iris position
Iris size
Pupil size
Anterior curve
Posterior curve

Finally instructions socket hygiene and prosthetic care

are given along with the technique of removal and insertion
is given to the patient (Fig. 7).

Fig. 7. (a) Twenty-eight-year-old male following retinal surgery lost eye, and referred for prosthesis for his phthisical left eye; (b) fitted with the well-fitted
custom scleral prosthesis restore the cosmetic appearance.

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159

Fig. 8. (af) Ideally fitting custom ocular prosthesis with symmetrization and good movements; (g) conformal shape of custom ocular prosthesis.

11. Ideal prosthesis

A prosthesis with a total thickness about 7 mm anteroposteriorly ideally should have 1 mm thickness for the iris
disc, 3 mm for anterior chamber and another 3 mm for the
peg. It should be light exerting minimal to no pressure upon
orbital tissues in the socket. It must achieve acceptable
conversational movement in all gazes [32] (Fig. 8af). The
material must be inert in nature. It should effectively correct
the volume deficit and match the appearance of the fellow
eye as well. If the socket does not meet these criteria, most
often the cosmesis is compromised.

12. Ideal socket

Kaltreider [32] defines an ideal socket as a socket with
adequately deep fornices, the volume loss not exceeding
4.2 ml. It should have a well-centred orbital implant with
quiet conjunctiva and no granulomas. There should be no
blepharoptosis, eyelid malpositioning or laxity, sulcus
deformity, socket contracture, lagophthalmos. Very often
sockets does developed various kind of deformities and thus
fitting of a prosthesis is a really challenge. Allen had
described in the literature of correcting the various
deformities using the modified impression technique.

As in most of the case, impression of the prosthesis need

to be modified, due to socket uniqueness, as Allen already
had described the various method and that is why most of the
time even in the absence of ideal socket a good cosmetic
appearance can be achieved with the modified impression
technique (MIM). In the absence of inadequate space in the
cavity, socket reconstruction surgery can be performed and
later custom prosthesis can be provided.

14. Important consideration

Movement of prosthesis depends on the size, type of
orbital implant and the fitting of a custom ocular prosthesis
[3335]. To cite a few examples, an inferiorly migrated
implant will exhibit sub optimal movement in all direction.
Similarly small implant size makes it deep seated and
therefore does not allow optimal transfer of movement to the
overlying prosthesis. Compared to a non-integrated implant
an integrated one shows much better movement especially
when coupled (either with peg or magnets) to the ocular
prosthesis. Therefore prevention of socket contracture by
minimal tissue handling by the surgeon followed by custom
fitted ocular/orbital prosthesis gives excellent cosmetic
results.

15. Custom versus stock prosthesis

13. Prerequisites for a good prosthetic fitting







Deep fornices in all quadrants

Normal tear secretion
Effective volume replacement with orbital implants [38]
Adequate orbital fat
Well-centered and covered orbital implant
Absence of socket inflammation

Poor apposition between stock prosthesis and surface

leads to unequal weight distribution, constant irritation of
the surface. This presents in the form of chronic discharge
and laxity of the lower eyelid in the patient in the long term
(Fig. 9ac). In comparison a custom moulded prosthesis
allows even distribution of volume and weight in the socket
giving better cosmetic and less discomfort to the patient in

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Fig. 9. (a) The comsesis appearance with a stock prosthesis, poor colour matching poor distribution of volume; (b) shows a stock prosthesis; (c) shows a gap
between the ocular cavity and the ocular prosthesis which does allow the tear film and mucous to accumulate behind the cavity and eventually lead to excessive
pressure on the ocular globe and pain in the cavity; (d) shows a appearance of right eye custom made ocular prosthesis; (e) shows custom prosthesis and variable
in shape as per the impression of the cavity; (f) shows the flush fitting appearance of the ocular prosthesis and does not allow the place for accumulation of the
mucous and water.

the long term (Fig. 9df). Moreover it allows correction of

deep superior sulcus, mild degrees of blepharoptosis and
acceptable cosmesis in socket with cicatricial bands.
In concern with the empirical fitting of an ocular
prosthesis where a prosthesis is tightly fitted as close as
possible, most likely it leaves the vaulted spaces in the cavity
and leads to pooling of the tears and mucous secretion, as
day passes and the shell is on the cavity patient starts feeling
the heaviness in cavity and results in removing the prosthesis
from the cavity, while a custom made modified impressionbased prosthesis provides the very close contact with the
socket, thus fitted well in conjunction with orbital soft tissue
and leaves no space or pooling to accumulate the tear fluid.
Moreover the close contact with orbital tissue and provide
the conditioning of the socket and henceforth reduce the
mucous secretion from the cavity (Fig. 9f).

16. Advances in ocular prosthesis

Traditionally ocular prosthesis has been associated with
dryness, allergy, limited ocular movements and laxity of lower
eyelids. Walter first described creation of sulcus crutch to
correct the sulcus deformity [29]. Solid prosthetic devices
have considerable weight, which is borne by the lower eyelid
invariably leading to significant laxity in the longer term. This
led to the creation of hollow prosthetic devices [37] (Fig. 10a
c). This involves making the prosthesis as two separate pieces
in metal moulds, which are then joined together. This allows
reduction in the overall weight of the prosthesis by as much as
26%. This concept cannot work with all type of prosthesis
specially a thin prosthesis, where making two separate pieces
and again join together leaves no place on the back surface for
polishing and may lead to perforate the shell.

Allen, Kolder and Bulgarelli conducted a study to

demonstrate deficient tear production in anophthalmic
socket as compared to normal eyes [31]. They inferred
that artificial lubricants may be beneficial in people wearing
artificial eyes. Kelly from Philadelphia designed the selflubricating ocular prosthesis called SLPTM [30]. SLPTM
provides the needed lubrication to the artificial eye surface
for the relief of dryness and related problems. The SLPTM
has three main elements, a chamber that holds the lubricant,
an exit hole or fenestration and a releasable cap covering the
chamber. During normal blinking lubricant is drawn out of
the chamber, lubricating the surface of the prosthesis
(Fig. 8). After removal of the cap the patient can clean the
chamber with typical contact lens solution type cleaner and
small brush, the chamber is refilled with lubricant and the
prosthesis replaced. This kind of special prosthesis is of
great help for the radiated anophthalmic sockets and dry
anophthalmic sockets where absence of tears and very
minimal tears create in tolerating the prosthesis.
Achieving near normal motility of the prosthesis has been
the subject of extensive research. Improvement in prosthesis
motility has been achieved by improvement in surgical
technique like myoconjunctival technique [38] and use of
integrated implants. Pegging of the orbital implants allows
direct transfer (9095%) of motility to the prosthesis [3335].

17. Care for the ocular prosthesis, eyelids and eye

socket
17.1. Daily routine
The morning routine for hygiene care begins with a
thorough hand scrub including the fingertips [38]. A warm

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161

Fig. 10. (a) The sagging of left lower eyelid with a solid prosthesis; (b) excellent symmetry and correction of left lower eyelid sagging with a lightweight hollow
prosthesis; (c) solid and hollow prosthesis immersed in water showing lighter weight of the latter.

wet face cloth with a no more tears baby shampoo is then

applied to the eyelids since they are normally crusted with
secretion. (This shampoo has a neutral pH and will not sting
to the socket tissue or the fellow eye, plus it destroys
bacteria.) The warm wet face cloth will soften the secretion
allowing you to remove it by wiping inward toward the nose.
(Do not wipe outward, because this could rotate the
prosthesis out of position, or cause it to fall out of the cavity.)
Always carry a pocket pack of tissue and use it when
necessary to remove any secretion from the prosthesis or
lids. The average amount of wiping is three to five times a
day. Avoid the use of a handkerchief or bare fingers.
Following removal, the prosthesis should be cleaned
before insertion. Never clean the prosthesis with a cloth,
abrasive soap, or toothpaste. The prosthesis is best cleaned
with a mild soap or baby shampoo, with wet hands, gently
wash the prosthesis between soapy fingers. All soap must be
rinsed from the prosthesis and hands before reinsertion of
the prosthesis.
As the prosthesis is made of an acrylic plastic, it should
never be soaked in alcohol, gasoline or bleach. Do not
attempt to sterilize the prosthesis in an autoclave. In the
office prosthesis can be disinfected in a cold sterilization
media such as Cidex (manufactured by Surgikos Johnson &
Johnson Co.) [39].

18. Surface cleaning of the prosthesis and eyelids

Excessive mucous secretions can occur when wearing an
ocular prosthesis. Conditions such as head colds, winds dust,

allergies and dirty hands can cause considerable secretion.

Regular rinsing of the prosthesis with an ophthalmic irrigation
solution can cause usually dislodged any surface deposits [39].
19. Consulting the ocularist
There is no definite answer as to how long the prosthesis
will last. Unlike the old style glass prosthesis, modern plastic
prosthesis are durable and will not break. They can be
polished when they become pitted or scratched. Plastic
prosthesis can be increased or reduced in size as required by
changes in the design of the anophthalmic socket. Changes
in the socket occur from fat atrophy in the deep orbit and
growth development in children. It is recommend the adult
patient to be seen yearly and children every 6 months for a
check of the condition and fit of the ocular prosthesis [39].

20. Consulting the ophthalmologist

The patient is encouraged to keep all follow-up
appointment prescribed by the ophthalmologist. In addition,
condition such as chronic discoloured secretion, pain, or
socket bleeding must be immediately brought to the
attention to ophthalmologist [39].

References
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[2] Gordon B. The ancient origins of artificial eyes. In: Annuals of medical
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[3] Martin O, Clodious L. The history of artificial eyes. Ann Plastic Surg
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Further reading
[8] Dixit S, Shetty P, Bhat GS. Ocular prosthesis in childrenclinical
report. Kathmandu Univ Med J 2005;3(1):813.

[9] Klein BE, Karlson TA, Rose J, Rose J. An anatomic index for the
severity of ocular injuries. Eur J Ophthalmol 1993;3(2):5760. Koetting
RA.
[10] Cosmetic contact lenses in the care of the child. J Am Optom Assoc
1979;50(11):12459.
[14] Yildirim N, Basmak H, Sahin A. Prosthetic contact lenses: adventure
or miracle. Eye Contact Lens 2006;32(2):1023.
[15] Looi A, Kazim M, Cortes M, Rootman J. Orbital reconstruction after
eyelid- and conjunctiva-sparing orbital exenteration. Ophthal Plast
Reconstr Surg 2006;22(1):16.
[16] Puri T, Gunabushanam G, Sharma R, Kumar S, Julka PK. Extensive
bone metastases from basal cell carcinoma of the eye. Singapore Med J
2006;47(9):8113.
[17] Cockerham KP, Bejjani GK, Kennerdell JS, Maroon JC. Surgery for
orbital tumors. Part II. Transorbital approaches. Neurosurg Focus
2001;10(5):E3 [Review].
[18] Ajaiyeoba A, Akang E, Olusanya B. Retinoblastoma presenting with a
cheek mass. J Natl Med Assoc 2005;97(11):15535.
[19] Su GW, Patipa M, Font RL. Primary squamous cell carcinoma arising
from an epithelium-lined cyst of the lacrimal gland. Ophthal Plast
Reconstr Surg 2005;21(5):3835.
[20] Hotta K, Arisawa T, Mito H, Narita M. Primary squamous cell
carcinoma of the lacrimal gland. Clin Exp Ophthalmol 2005;33(5):
5346.
[21] Tatla T, Hungerford J, Plowman N, Ghufoor K, Keene M. Conjunctival
melanoma: the role of conservative surgery and radiotherapy in
regional metastatic disease. Laryngoscope 2005;115(5):81722.
[22] Leibovitch I, McNab A, Sullivan T, Davis G, Selva D. Orbital invasion
by periocular basal cell carcinoma. Ophthalmology 2005;112(4):717
23.
[23] Shields JA, Demirci H, Marr BP, Eagle RC, Stefanyszyn Jr M, Shields
CL. Conjunctival epithelial involvement by eyelid sebaceous carcinoma. The 2003 J. Howard Stokes lecture. Ophthal Plast Reconstr
Surg 2005;21(2):926.
[24] Yeatts RP. The esthetics of orbital exenteration. Am J Ophthalmol
2005;139(1):1523.
[25] Ben Simon GJ, Schwarcz RM, Douglas R, Fiaschetti D, McCann DJ,
Goldberg RA. Orbital exenteration: one size does not fit all. Am J
Ophthalmol 2005;139(1):117.
[26] Goisis M, Biglioli F. Relining contracted sockets. Plast Reconstr Surg
2005;115(1):3478.
[27] Greene AK, Burrows PE, Smith L, Mulliken JB. Periorbital lymphatic
malformation: clinical course and management in 42 patients. Plast
Reconstr Surg 2005;115(1):2230.
[36] Young CW. Lack of motility in ocular prosthetics. Todays Ocularist
1977;7:10.