Comm Eye Health Vol. 19 No. 58 2006 pp Community Eye Health J 2006;19(58): 31. Published online 01 June 2006.

Assistance in developing a custom-made prosthetic eye service

Colin Haylock

Consultant Maxillofacial Prosthetist, Charing Cross Hospital, Fulham Palace Road, London W6 8RF, UK.

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The acceptance level of patients fitted with stock reform, or average-shaped, scleral shells over blind unsightly phthisical eyes, is very low and is often associated with discomfort leading to eye and socket infection and, in some cases, Giant Papillary Conjunctivitis (GPC). When associated with ocular prosthetics, GPC is a disorder that is caused by the conjunctiva lining of the eye socket being subjected to persistent trauma from surface abrasions or ill-fitting ocular prostheses. A small percentage of patients will not tolerate the fitting of a scleral shell prosthesis, due to underlying symptoms causing the phthisical eye to be sensitive and painful. However, this sensitivity can be caused from mechanical entropion, the eyelids being unsupported by the reduction of eye volume and the eyelashes rotating inwards.

In this situation, a custom-made prosthetic scleral shell will restore the volume deficiency and elevate the lashes, resolving the symptoms and improving appearance. To construct a custom-made scleral shell, the shape and volume of the eye socket is recorded by using an alginate impression supported by a thin tray. From the subsequent impression, a trial scleral shell is constructed in clear acrylic resin; this is highly polished and worn by the patient who increases the wearing schedule by an hour per day. This gradually desensitises the underlying phthisical eye and increases the tolerance level. The clear shell is ultimately converted into the custom-made scleral shell, at which time every endeavour is made to reproduce an exact copy of the patient’s other eye.

The stigma and effects of losing an eye, especially in developing countries, can be tragic to the individual and their family, often hampering the prospects of social and professional development. To overcome this great divide in the provision of custom-made eye prostheses, International Ocular Prosthetic Services provide voluntary assistance overseas and training of local staff in the construction of custom-made indwelling eye prosthesis techniques. This charitable service is provided free to patients or requesting hospitals in most situations.

For information and advice on custommade indwelling eye prostheses contact IOPS email: iops@hotmail.co.uk