OCULAR AND

ORBITAL PROSTHESIS
GUIDED BY: PRESENTED BY:
DR.B.MUTHUKUMAR MDS AKSHAYAA B
PROFESSOR & HOD III YR PG
DR.J.BRINTHA JEI MDS
READER
INTRODUCTION

A maxillofacial prosthesis that

artificially replaces an eye
missing as a result of trauma,
surgery, or congenital absence;
the prosthesis does not replace
missing eyelids or adjacent skin,
mucosa or muscle.
 OCULAR
PROSTHESIS ORBITAL
PROSTHESIS

A maxillofacial prosthesis that

artificially restores the eye,
eyelids, and adjacent hard and
soft tissues;
HISTORY
15th
Century-
Egyptians-
Babylonia Boissonea
n and u in
Sumerian- 1849-”ocul
”art eyes” arist”

Pare from 1853-

Paris- Ludwig
hyplepharon & Muller Uri
eclepharon
1954-India-eastern
parts 2002

1958- ‘‘American
Society of
Ocularists’’
ANATOMY
EPIDEMIOLOGY

PINE KR, SLOAN BH, JACOBS RJ. CLINICAL OCULAR PROSTHETICS. CHAM: SPRINGER INTERNATIONAL PUBLISHING; 2015 JUL 10.
 PSYCHOSOCIAL IMPORTANCE
Physical and
cosmetic
characteristic
s

Quality of-life Physical

scores appearance

Convenience

CHIN K, MARGOLIN CB, FINGER PT. EARLY OCULAR PROSTHESIS INSERTION IMPROVES QUALITY OF LIFE AFTER ENUCLEATION. OPTOMETRY-JOURNAL OF THE AMERICAN OPTOMETRIC
SURGICAL REMOVAL OF EYE

EVISCERATION

ENUCLEATION

EXENTERATION
 EVISCERATION ENUCLEATION EXENTERATION

• Removal of • Removal of • Removal of the

contents of eye entire globe eye and a
leaving only variable amount
sclera with or of orbital and
without cornea adnexal tissue.
EVISCERATION
ENUCLEATION
EXENTERATION
PATIENT EVALUATION

Health of
remaining eye
Psychological
assessment

Medical
history

CAFIERO-CHIN M, MARQUES C, DANZ HJ. OCULAR PROSTHESIS: INDICATIONS TO MANAGEMENT. CANADIAN JOURNAL OF OPTOMETRY. 2015 JUL 6;77(2):24-.
 Assessment of
Assessment of Assessment of
existing
visual prosthetic eye
prosthetic eye
perception exsitu
insitu
Assessment of
Assessment of Inflammation
anophthalmic
tears of socket
socket

Papillary
Meibomian
texture of
gland loss
conjunctiva
FABRICATION OF PROSTHESIS

CUSTO
STOCK
M
IMPRESSION MAKING

• Accuracy of recording the posterior wall

• Position of the palpebral in relation to the posterior wall.

• Greatest extent of the superior and inferior fornics.

BROWN KE. FABRICATION OF ORBITAL PROSTHESIS. THE JOURNAL OF PROSTHETIC DENTISTRY. 1969 NOV 1;22(5):592-607.
OCULAR TRAY IMPRESSION
TECHNIQUE
MODIFICATIONS

Brown advocated an external impression

tray technique in which the ophthalmic
irreversible
alginate is mixed and injected into the
ocular defects
Taylor advocated placing the perforated
acrylic resin backing tray for
reinforcement.

Engelmeier
Suggested casting a
set of stock trays in
ticonium
IMPRESSION MIXING GUN
TECHNIQUE

• An impression mixing gun

• A disposable mixing tip and a cartridge containing fast set, heavy body
polyvinylsiloxane impression material
• Directly into the anophthalmic socket as it emerges from the end.
CUSTOM STOCK TRAYS
• In cases where an ophthalmic socket was highly irregular or stock trays may not be available, use
of a custom ocular tray was suggested by Miller.

• He attached a solid suction rod to the patient’s existing prosthesis, conformer, or wax shell and
invested it in an alginate mold. After the alginate sets, the prosthesis, conformer, or wax is
removed and replaced with clear acrylic resin. Perforations are made in the resulting tray, and a
tunnel is cut into the stem through which impression material can be delivered. An impression is
made using injected alginate
 WAX SCLERAL BLANK TECHNIQUE

Benson created a wax blank by adapting baseplate wax

around half of an appropriately sized steel ball. The
resultant pattern is smoothed, tried in, and adjusted. After
the addition of an iris button, the pattern is invested and
processed.

MATHEWS MF, SMITH RM, SUTTON AJ, HUDSON R. THE OCULAR IMPRESSION: A REVIEW OF THE LITERATURE AND PRESENTATION OF AN ALTERNATE TECHNIQUE. JOURNAL
OF PROSTHODONTICS. 2000 DEC;9(4):210-6.
 FUNCTIONAL IMPRESSION TECHNIQUE FOR
AN OCULAR PROSTHESIS

• A functional ocular impression technique is

presented to achieve a better fit of the prosthesis
to the defect area.
• This technique aims to combine cosmetic
excellence with comfort for greater benefit to
the patient.

JETHWANI J, JETHWANI GS, VERMA AK. FUNCTIONAL IMPRESSION TECHNIQUE FOR AN OCULAR PROSTHESIS. THE JOURNAL OF INDIAN PROSTHODONTIC SOCIETY. 2012
CASTING THE IMPRESSION

2 part gypsum plaster mould

One part silicone mould
PREPARATION OF WAX PATTERN
ALTERNATIVE TECHNIQUE
WAX TRY IN
Curvature
Size of of the
the eye globe

Direction Contour
of gaze of the
eyelids
Palpebral fissure and the
anterior curvature of the
globe are as similar to the
companion eye as
possible
POSITIONING THE IRIS
With sclera in placed
and patient standing
in a relaxed position

Center of pupil
marked in
comparison with the
natural eye

Circle scribed of
diameter of natural
eye

Consider the iris in

relation to opening of
eye lid 
PUPILOMETER
The method presented in this article uses a
transparency projection from which a tracing of
prominent facial features is made. The transfer
of these dimensions to the facial cast reduces
the chairside time that is necessary to position
the pupil and orbital bulb.

JOOSTE CH. A METHOD FOR ORIENTING THE OCULAR PORTION OF AN ORBITAL PROSTHESIS. THE JOURNAL OF PROSTHETIC DENTISTRY. 1984 MAR 1;51(3):380-2.
GUTTAL SS, PATIL NP, VERNEKAR N, PORWAL A. A SIMPLE METHOD OF POSITIONING THE IRIS DISK ON A CUSTOM ‐MADE OCULAR PROSTHESIS. A CLINICAL REPORT. JOURNAL OF
PROSTHODONTICS. 2008 APR;17(3):223-7.
 DIGITAL IMAGING IN THE FABRICATION OF
OCULAR PROSTHESES

ARTOPOULOU II, MONTGOMERY PC, WESLEY PJ, LEMON JC. DIGITAL IMAGING IN THE FABRICATION OF OCULAR PROSTHESES. THE JOURNAL OF PROSTHETIC DENTISTRY. 2006
PROCESSING OF EYE PROSTHESIS
 IRIS PAINTING

• Depending on the surface, different paints can be

applied such as varnishes and gouache, acrylic, oil, and
automotive paints.
• Oil paint has better color stability when exposed to
degradation action and environmental agents.
Fine veins are teased from red embroidery thread and carefully
laid on the sclera in the same manner and amount as observed in
the patient’s companion eye
 FINISHING
Pronounced irregularities on the fitting surface are smoothed over before
the entire surface is ground with a fine arbour band.

Buffed off with a paste of pumice and water applied with a calico mop
followed by a felt cone

The fine marks left by the pumice are removed with a polishing
compound such as tripoli

An optical quality contact lens standard of polish is obtained using aluminium oxide
paste, applied with a foam polyurethane rotating cone or wheel. This final step reduces
trace lines from the polishing mop and removes wax residues.
SCLERAL SHELL PROSTHESIS

Eyeball has become disfigured

and unsightly, a scleral shell
prosthesis or a prosthetic
contact lens is used to mask the
defect.
SILICONE EYE PROSTHESIS

• Flexible material
• Defect encounters movable tissues
HAFEZEQORAN A, KOODARYAN R. A TECHNIQUE FOR FABRICATION OF AN ORBITAL PROSTHESIS: A CASE REPORT. JOURNAL OF DENTAL RESEARCH, DENTAL CLINICS,
DENTAL PROSPECTS. 2010;4(2):69.
MODES OF RETENTION

Adhesives Undercuts Spectacles Orbital

implants
IMPLANTS

• Placed in tissue bed to aid in prosthesis retention

• Implant moves as muscles move in normal course, results in more realistic
prosthesis 
 Mechanical
Non- Quasi- Magneticall
ly
integrated integrated y integrated
integrated

Porous-
Porous quasi Biogenic
integrated

BAINO F, POTESTIO I. ORBITAL IMPLANTS: STATE-OF-THE-ART REVIEW WITH EMPHASIS ON BIOMATERIALS AND RECENT ADVANCES. MATERIALS SCIENCE AND ENGINEERING:
BAINO F, PERERO S, FERRARIS S, MIOLA M, BALAGNA C, VERNÉ E, VITALE-BROVARONE C, COGGIOLA A, DOLCINO D, FERRARIS M. BIOMATERIALS FOR ORBITAL IMPLANTS AND
OCULAR PROSTHESES: OVERVIEW AND FUTURE PROSPECTS. ACTA BIOMATERIALIA. 2014 MAR 1;10(3):1064-87.
AN INNOVATIVE METHOD OF OCULAR PROSTHESIS
FABRICATION BY BIO-CAD AND RAPID 3-D PRINTING
TECHNOLOGY: A PILOT STUDY

Converted to 3D
Refined using 3-
Preparation of CT scan image of image using
Matic software
wax model wax model MIMICS
and made hollow
software

Input to rapid Prototype model

Painting of iris Final prosthesis
prototyping is ready

MD. SHAHID ALAM, M. SUGAVANESWARAN, G. ARUMAIKKANNU & BIPASHA MUKHERJEE (2017): AN INNOVATIVE METHOD OF OCULAR PROSTHESIS
FABRICATION BY BIO-CAD AND RAPID 3-D PRINTING TECHNOLOGY: A PILOT STUDY,
A NEW METHOD FOR FABRICATING ORBITAL
PROSTHESIS WITH A CAD/CAM NEGATIVE
MOLD
BI Y, WU S, ZHAO Y, BAI S. A NEW METHOD FOR FABRICATING ORBITAL PROSTHESIS WITH A CAD/CAM NEGATIVE MOLD. THE JOURNAL OF PROSTHETIC DENTISTRY. 2013
FABRICATION OF A BICOMPONENT HYBRID
ORBITAL PROSTHESIS

JAIN RA, VERMA M, GUPTA R, GILL S, GHOSH M. FABRICATION OF A BICOMPONENT HYBRID ORBITAL PROSTHESIS. THE JOURNAL OF PROSTHETIC DENTISTRY. 2019
DEC 1;122(6):568-72.
 COMPLICATIONS

Loss of prosthesis retention

Deficiency of
lining
Deficiency of
fornix

Adhesions

Lower eyelid
laxity
BONAQUE-GONZÁLEZ S, AMIGÓ A, RODRÍGUEZ-LUNA C. RECOMMENDATIONS FOR POST-ADAPTION CARE OF AN OCULAR PROSTHESIS: A REVIEW. CONTACT LENS AND
ANTERIOR EYE. 2015 DEC 1;38(6):397-401.
 Adhesions
Loss of stability
Eyelid
Lower eyelid malposition
Enophthalmos
laxity
Limited
Implant prosthesis
position/migration motility

Rotation
CONCLUSION

• The disfigurement resulting from loss of eye can cause significant

psychological, as well as social consequences.
• However with the advancement in ophthalmic surgery and ocular prosthesis,
patient can be rehabilitated very effectively.
• The maxillofacial Prosthodontist should provide prosthetic treatment to the
best of his/her ability and should also consider psychological aspects and if
necessary the help of other specialist should be taken into consideration
REFERENCES
• Pine KR, Sloan BH, Jacobs RJ. Clinical ocular prosthetics. Cham: Springer International Publishing; 2015 Jul 10.
• Cafiero-Chin M, Marques C, Danz HJ. Ocular prosthesis: indications to management. Canadian Journal of Optometry.
2015 Jul 6;77(2):24-.
• Chin K, Margolin CB, Finger PT. Early ocular prosthesis insertion improves quality of life after enucleation. Optometry-
Journal of the American Optometric Association. 2006 Feb 1;77(2):71-5.
• Brown KE. Fabrication of orbital prosthesis. The Journal of Prosthetic Dentistry. 1969 Nov 1;22(5):592-607.
• Guttal SS, Patil NP, Vernekar N, Porwal A. A Simple Method of Positioning the Iris Disk on a Custom‐Made Ocular
Prosthesis. A Clinical Report. Journal of Prosthodontics. 2008 Apr;17(3):223-7.
• Artopoulou II, Montgomery PC, Wesley PJ, Lemon JC. Digital imaging in the fabrication of ocular prostheses. The
Journal of prosthetic dentistry. 2006 Apr 1;95(4):327-30.
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review. Contact Lens and Anterior Eye. 2015 Dec 1;38(6):397-401.
• Hafezeqoran A, Koodaryan R. A technique for fabrication of an orbital prosthesis: A case report. Journal of dental research, dental
clinics, dental prospects. 2010;4(2):69.
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and Engineering: C. 2016 Dec 1;69:1410-28.
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prosthesis fabrication by bio-CAD and rapid 3-D printing technology: A pilot study,
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prosthetic dentistry. 2013 Nov 1;110(5):424-8.
• Jain RA, Verma M, Gupta R, Gill S, Ghosh M. Fabrication of a bicomponent hybrid orbital prosthesis. The Journal of Prosthetic
Dentistry. 2019 Dec 1;122(6):568-72.
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prosthesis. The Journal of Indian Prosthodontic Society. 2008 Apr 1;8(2):112.
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Prosthodontic Society. 2012 Mar;12(1):55-8.
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alternate technique. Journal of prosthodontics. 2000 Dec;9(4):210-6.