On artificial eyes29th May 2016

Dr. Anton VurdaftFCOphth(ECSA), FICO

Few simple concepts regarding artificial

eyes in anophthalmic

patients

Any eye removal necessitates orbital implantation

•Why?

Primary orbital implants in retinoblastoma: DOI: 10.1111/aos.12915, 10.1371/journal.pone.0121292

Any eye removal necessitates orbital implantation

Anophthalmic Socket Syndrome:Loss of volume,Deepening of upper Lid sulcus,Shrinkage of fornices

Any eye removal necessitates orbital implantation

(!) Inability to insert an artificial

eye in the long term

Any eye removal necessitates orbital implantation

(!) Inability to insert an artificial eye in the long term

On the picture:Severe socket constriction

(upper and lower fornices – flat)

Any eye removal necessitates orbital implantation

(!) Inability to insert an artificial eye in the long term

On the picture:Severe socket constriction

(upper and lower fornices – flat)

Upon completing the surgery – put tetracycline ointment

and a big conformer to stretch the conjunctival fornices. Apply crape

bandage for 24 to 72 hours or perform temporal

tarsorrhaphy.•Why?

Perform Tarsorrhaphy at the End

Severe chemosis in the postop days after evisceration with orbital implant

Counsel the patient accordingly preoperatively and postoperatively (What?

Why? What’s next?)

•Why?

Counsel properly!

She was not offered an artificial eye before the removal. She has got lower lid ectropion and shallow fornices instead!

Fitting of the artificial eye: after 6-8 weeks

Artificial eye will move naturally only in

conversational distance (not able to deviate to the

extreme gaze positions)

Patient should be taught how to insert and remove the eye (devote separate time, quiet

room and a mirror)

© Murray McGavinhttp://www.cehjournal.org/article/management-of-an-eye-prosthesis-or-conformer/

Notch is superonasally!

Patient should be encouraged to minimize handling the

artificial eye.

No daily removal and cleaning is necessary.

Lubrication may improve comfort (no tap water!

Ringers, Saline or Artificial Tears may work well instead,

packed in the eyedrops bottles)

There is only one eye now. Encourage using the

protective plastic glasses.

Evaluating the socket of anophthalmic patient:1) Socket is fit or infmalmed?2) Lower lid is healthy or lax?3) Can the patient blink naturally?4) Any lagophthalmos?5) Are the fornices deep enough?6) Giant papillae of upper tarsal conj?

Evaluating the prosthesis1) Artificial eye is well centered?2) Horizontal symmetry?3) Equal prominence?4) High gloss, wet shine?5) Scratches, debris of the surface?6) Moving naturally within 10-15

degrees?

One artificial eye should serve for 6-8

years.Easily gets damaged while dropped down.Advise annual check

up.

Thank you“On Artificial Eyes”Dr. Anton Vurdaft

FCOphth(ECSA), FICO