|Year : 2016 | Volume
| Issue : 2 | Page : 108-110
Ocular Prosthesis in Phthisis Bulbi: Patient Rehabilitation
Sumit Kumar Chattopadhyay1, Pratheek Shetty1, Sachin Sinha2
1 Department of Prosthodontics, Awadh Dental College and Hospital, Jamshedpur, Jharkhand, India
2 Department of Periodontics, Awadh Dental College and Hospital, Jamshedpur, Jharkhand, India
|Date of Web Publication||12-Sep-2016|
Sumit Kumar Chattopadhyay
Department of Prosthodontics, Awadh Dental College and Hospital, Jamshedpur, Jharkhand
Source of Support: None, Conflict of Interest: None
Normal facial appearance is one of the inherent human traits, which if altered or lost, challenges the patient's physical, psychological and mental well-being as well as maxillofacial prosthodontics' ingenuity. Maxillofacial prostheses, which restore and replace stomatognathic and associated facial structure with artificial substitute, aim to improve the quality of life along with the mental satisfaction. This article describes a technique by which the state-of-the-art custom ocular prostheses has been fabricated in a case of 'Phthisis Bulbi' by making an accurate functional impression with the fine details of the eye socket and following all the steps of fabrication meticulously.
Keywords: Ocular prosthesis, prosthodontics, rehabilitation
|How to cite this article:|
Chattopadhyay SK, Shetty P, Sinha S. Ocular Prosthesis in Phthisis Bulbi: Patient Rehabilitation. Adv Hum Biol 2016;6:108-10
| Introduction|| |
The disfigurement associated with the loss of an eye can cause significant physical and emotional problems. The rehabilitation of the patient who has suffered the psychological trauma of an ocular loss requires a prosthesis that will provide the optimum cosmetic and functional result. The art of making artificial eyes has been known to humans from early Egyptian and Peruvian Indian times but not until World War II. The first in-socket artificial eye was made in the 15th century with gold and coloured enamel. In the late 16th century, the Venetian glass artisans discovered a formula that could be tolerated inside the eye socket, but the major disadvantage was its fragility. Today, the majority of ocular prosthesis worn by the patients are made out of acrylic. Several techniques have been used for fabrication and well fitting of the prostheses. Empirically fitting stock eye, modifying the stock eye by making the impression of the defected eye socket  and custom eye technique are the most commonly used techniques worldwide. Among all the eye defects, the condition called 'Phthisis Bulbi' demands a major place in and around the world. It is a condition where the eye becomes unsightly, small, shrunken and non-functional but has not deteriorated to a condition that requires evisceration or enucleation. Such defect will give mental and psychological dissatisfaction to the patient. Artificial prostheses should be provided as soon as possible to improve the spirit and ease of mind of the afflicted patients and re-instate them to acceptable normalcy.
| Case Report|| |
A 54-year-old male reported to the Department of Prosthodontics, Awadh Dental College and Hospital, Jamshedpur, with a defect in the right eye [Figure 1]. On taking a detailed history, it was found that the patient had a traumatic injury to his right eye in childhood. On examination, it was found that the patient was having unsightly, small, shrunken and non-functional right eye, and thus the patient was diagnosed with 'Phthisis Bulbi.' The patient then underwent clinical and laboratory procedures for a successful ocular prosthesis.
Four percentage of lignocaine hydrochloride solution was used as a surface anaesthetic agent to reduce the irritability. The upper and lower eyelids were stretched, and the petroleum jelly (Vaseline, Hindustan Lever, Mumbai) was applied on both the lids to facilitate the easy removal of the impression from the socket.
Light body addition silicone impression material (Flexeed, GC, Japan) was mixed and loaded into a 2 ml disposable syringe for easy disposing. The defected eye socket was overfilled with the impression material, and the patient was asked to do the eye movements along with the normal eye. This allows the impression material to flow into the underlying muscle bed and all the anatomical areas to record them more accurately. Once the impression material was set, the patient was instructed to blink his eye to break the air seal, and the impression was carefully removed from the socket and visualised for any void or any defect. Trimming of the excess material was carefully done with the help of a B.P. knife and a fine scissor at the palpebral fissure.
Formation of the stone cast
The impression was poured in three sections.First, the upper third of the impression was poured. After the stone had set, keyholes were cut and the boxing was done around the first layer using the modelling wax, after which a separating medium (Cold Mould Seal, DPI India Pvt Ltd., Mumbai, India) was applied. Then, after drying of the separating medium, the second layer was poured to cover the middle third of the impression. Again, the keyholes were cut and the final pour was made. After it had set, the three sections were separated carefully, and the middle was sawed and separated to remove the impression.
Preparation of wax pattern
The second and final layers of the cast were assembled and immersed in water for a few minutes. Modelling wax was poured into the cast. Once the wax hardened, the mould was opened and the wax pattern was removed. Sharp ridges and undesirable irregularities were eliminated and the pattern of the wax that represented the palpebral fissure was recontoured to form a smooth convex surface.
Try-in of the wax pattern
The wax pattern was inserted into the patient's eye socket to check the proper contour and the bulk. Necessary modifications were carried out. The pattern was repolished and again inserted into the patient's defected eye socket. This was made until the soft tissue contour and the palpebral fissure resembled the patient's normal eye. The patient was asked to look towards a straight angle to a certain distance, and the landmarks were marked on the wax pattern for the placement of the prefabricated iris button of the appropriate size and texture and the shade provided by the ophthalmologist.
Then, a space was created by melting the wax on the wax pattern, and the iris button was placed on the predetermined position. The wax was again smoothened. The wax pattern was again placed in the eye socket of the patient and compared with the normal left eye. Once the soft tissue contour and the location of the iris were satisfactory, the pattern was removed and the shade of the scleral portion of the prostheses was selected using tooth-coloured acrylic material with the help of a shade guide.
Flasking and dewaxing were carried in a usual manner taking care that the iris button was secured firmly to one compartment of the flask. Heat polymerising tooth colour acrylic resin (Stellon, D.P.I) of an appropriate shade was used, and after doing a trial closure, the stains and veins were added to give a more natural appearance of the artificial eye. After acrylisation, prosthesis was removed and polished to get a smooth and shiny surface. Polished prosthesis was inserted into the eye socket [Figure 2].
Instructions to the patient
The following instructions were given to the patient:
Removal of the prosthesis should be done by pulling the lower eyelid down, gazing overhead and engaging the lower margin of the prosthesis with one finger so that it is expelled downwards into the hand. Insertion should be done by lifting the upper lid with the thumb and the forefinger sliding the prosthesis with other hand as much as possible under the upper lid and pulling the lower lid down to allow the prosthesis to slip into the socket. The patient was instructed to wear the prostheses at the day time only. At night, removal and washing with normal soap and keeping into a bowl of normal or saline water was advised. The patient was also instructed not to use alcohol to wash the prostheses.
| Discussion|| |
Fabrication of ocular prosthesis has been known to human being since times immemorial. Prosthetic rehabilitation fulfils aesthetic as well as psychological requirement of the patients. A correctly placed prosthesis should restore the normal opening of the eye, support the eyelid, restore the degree of movement and be adequately retained and aesthetically pleasing.
The ocular prostheses are either ready-made or custom-made and are produced from either glass or methyl methacrylate resin. Glass is not the material of choice as it is subject to damage and surface deterioration from contact with orbital fluids, leading to a usable life expectancy of only 18-24 months.
Custom-made prosthetic eye fabrication involves complex painting procedures in various stages that are time taking and based purely on painting skills of the operator. The technique to fabricate ocular prosthesis in the present case report modifies pre-fabricated eye prosthesis to a custom-made fit and esthetics. This helped us to overcome the disadvantages of poor fit, inadequate movement and complex painting procedure and technique involved in making a custom-made ocular prosthesis. This technique of incorporating iris portion from a stock eye into the custom ocular prosthesis is relatively easy to perform, along with saving on laboratory time. The close adaptation of the custom-made ocular prosthesis to the tissue bed provides maximum comfort and restores full physiologic function to the accessory organs of the eye.
| Conclusion|| |
The custom made scleral shell fabricated for the uniocular phthisis bulbi patient presented here, successfully restored the patient's esthetics and improved her social acceptance thereby, improving her quality of life. The customized ocular prosthesis demonstrated excellent fit, mobility and comfort. Rehabilitating a patient with uniocular phthisis bulbi is relatively less challenging when it is addressed early in the treatment period, than when there has been a long delay in treatment due to detrimental effects of loss of orbital volume and disuse atrophy of residual structures.
Declaration of patient consent
The authors certify that they have obtained all appropriate patient consent forms. In the form the patient(s) has/have given his/her/their consent for his/her/their images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
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[Figure 1], [Figure 2]