|Year : 2012 | Volume
| Issue : 1 | Page : 60-63
Prosthodontic rehabilitation of patient with ocular defect using an alternative technique
Laxman Singh Kaira1, Nag Bhusan Mandal2, S Swarajya Bharathi1
1 Department of Prosthodontics, Institute of Dental Sciences, Bareilly, Uttar Pradesh, India
2 Department of Prosthodontics, Budha Institute of Dental Sciences, Bihar, India
|Date of Web Publication||10-Sep-2012|
Laxman Singh Kaira
Room No 107, New Resident Hostel, Institute of Dental Sciences, Bareilly
Source of Support: None, Conflict of Interest: None
An ocular prosthesis is a simulation of of a perfectly normal healthy eye and surrounding tissues. The primary purpose of an ocular prosthesis is to maintain the volume of eye socket and create the illusion of a healthy eye and surrounding tissue. A custom ocular prosthesis is a good option when reconstruction by plastic surgery or the use of Osseo-integrated implants is not possible or not desired. Prosthetic rehabilitation of a patient with missing eye with custom made ocular prosthesis was described. Advantages include improved adaptation, increased mobility of prosthesis, improved facial contours and enhanced esthetics gained from the control of the iris and sclera. An accurate alignment of the artificial eye is one of the major prerequisites for esthetic success of the ocular prosthesis.
Keywords: Custom made ocular prosthesis, eye, ocular defect
|How to cite this article:|
Kaira LS, Mandal NB, Bharathi S S. Prosthodontic rehabilitation of patient with ocular defect using an alternative technique. J Orofac Sci 2012;4:60-3
|How to cite this URL:|
Kaira LS, Mandal NB, Bharathi S S. Prosthodontic rehabilitation of patient with ocular defect using an alternative technique. J Orofac Sci [serial online] 2012 [cited 2020 Dec 3];4:60-3. Available from: https://www.jofs.in/text.asp?2012/4/1/60/99882
| Introduction|| |
Eyes are generally the first features of face to be noticed. Removal of this organ either due to tumors, trauma or any other condition not only cause unaesthetic look but causes of function and has a psychological effect on the patient  . Thus, ocular prosthesis should be provided as soon as possible for the psychological well being of the patient. A congenital anomaly or pathology may necessitate an orbital orbital evisceration or an orbital enucleation or exenteration. The surgical procedure of evisceration is where the contents of the globe are removed, leaving the sclera and extraoccular muscles intact. A more invasive procedure is enucleation where there is removal of eye from the orbit while preserving all other orbital structures. Exenteration, which is the most radical, involves removal of the eye, adnexa and part of bony orbit. 
| Case Report|| |
A 35 years old female patient reported to the Department of Ophthalmology for the chief complaint of pain, bulging and whitish appearance of the right eye. She was diagnosed with anterior staphyloma after which enucleation was conducted. The patient was then referred to the Department of Prosthodontics, for the fabrication of an eye prosthesis. On examination, the defect area was found to be asymptomatic [Figure 1] and it was decided to fabricate an ocular prosthesis. The treatment plan was explained to the patient and an informed consent obtained.
Evaluation of patient ocular defect
In a case of evisceration the extra ocular muscles are left intact and hence good mobility of the prosthesis is possible. So it becomes mandatory to do the defect evaluations. In according to standard procedure; the palpebral fissure was observed both in open and closed position to rule out any abnormality.  Evaluation of the muscular control of the palpebrae and the internal anatomy of the socket in resting position and full excursive movement was performed. Mobility of the posterior wall of the defect was assessed. Condition of conjunctiva, depth of fornices, and presence of cul de sac was noted. 
Materials and techniques
The patient was placed in supine position and draped for the impression procedure. The remnants of the patients eyebrows and the area of the skin covering the defect and the upper two third of the face was lubricated with petroleum jelly.
Impression of ocular defect
Direct impression: A low viscosity alginate (Neocolloid Zhermack, Kab Dental supplies) is injected directly into the enucleated socket. The patient is instructed to stare straight ahead as the materials sets [Figure 2] and [Figure 3]. After the impression material was set, the impression was removed and invested in dental gypsum in order to obtain a positive cast of the eye socket. Subsequently the gypsum cast was coated with a separating medium and white paraffin wax was then shaped in an empirical approximation of the anterior curves of the investment form.
Try-in of sclera wax pattern
Wax was added or trimmed from the basic sclera pattern until satisfactory contours of the eyelids were achieved in open and closed positions [Figure 4].
Technique of iris disc placement:
- Transparent graph grid was used to attach iris disc.
- Certain guidelines were marked on patients face.
- The facial markings were transferred to grid by placing it on patients' face in place.
Transparent graph grid
Markings were made on grid template on X-axis from A to H starting from midline and on left side from A' to H'. Similarly, from 1 to 7 on Y axis and 1' to 7' on left side. The distance between each marking was 1cm on both X and Y axes.
Guidelines on patients face
A vertical midline was marked passing through the forehead crease, glabella, tip of the nose and chin. The distance from the right eye medial canthus to the midline and left eye medial canthus to the midline was measured. This distance standardized the midline marking and was used to reposition the grid template each time during the try-in visit. 
Evaluation with grid placed
The patient was asked to gaze straight at an object kept four feet away. The vertical lines coinciding with the with the medial and distal extremes. Similarly the horizontal lines referring to the inferior, center and superior limits were marked. 
Investing, dewaxing, packing
The finished pattern was invested in a small two piece brass flask. A two part mold was constructed by the prototype ocular shell by using dental gypsum in a two piece brass flask, the anterior portion of the mold was invested, a separating medium was applied and the posterior portion of the mold was then invested. The flask was then placed in a dewaxing bath for 20 minutes. The anterior and posterior portions of the flask were separated. The iris disc was shade matched with the adjacent eye and cut out from a stock eye. The color of the sclera was selected using tooth color acrylic shade guide. Rayon thread fibrils were used to simulate vasculature, by monomer polymer syrup method. The selected shade of the sclera was matched with the heat cure resin which was then packed in the two piece flask. The flask was kept for curing for a period of two hours and thirty minutes to avoid any residual monomer.
Placement of ocular prosthesis
The Patient Was Instructed On The Aspects Of Insertion And Easy Removal Of The Prosthesis [Figure 5]. Final Prosthesis Polished and Placed Into the Ocular Defect [Figure 6].
Patient follow up
The patient was asked to return on day 1, 2 and 7 for follow-ups after the prosthetic insertion. There after a 6 month follow-up was done for prosthesis evaluation and adjustment.
| Discussion|| |
Hence, early rehabilitation of this defect is of paramount importance to promote physical and psychological healing of the patient and social acceptance. The importance of an ocular prosthesis with acceptable esthetics and reasonable motility in patients with anopthalmia has been recognized since long time. The need for artificial eye can be satisfied by stock ocular prosthesis that comes in standard sizes, shapes and colors. These are relatively inexpensive and can be obtained quickly. ,,, Often, however which is indicated. A custom made ocular prosthesis has improved adaptation to underlying tissues, increased mobility, and enhanced esthetics due to control over the appropriate size of the iris, pupil and better matching ,improving the facial contours. ,,, The rehabilitation of the orbital defect is a complex task. Systemic conditions and financial constraints may limit their use. , However, the dilemma was regarding the choice of retention. Retention for extra oral prosthesis can be achieved by anatomic undercuts, magnets, and implants. Implants are ideal for retention but due to economic condition it was not opted. Retention in this case was primarily through anatomic undercut. ,,
Advantages of a custom ocular prosthesis are: 
- Retains the shape of the socket.
- Prevents collapse of the lids.
- Provides proper muscular activity of the lids.
- Prevents accumulation of fluid in the cavity.
- Maintains palpebral opening similar to natural eye.
- Has a gaze similar to natural eye.
- Mimics coloration and proportions of natural eye
| Conclusion|| |
The use of custom-made ocular prosthesis has been a boon to the patients who cannot afford for the implant placement. Also, as discussed above, the esthetic and functional outcome of the prosthesis was far better then the stock ocular prosthesis. Although the patient cannot see with this prosthesis, it has definitely restored her self-esteem and allowed her to confidently face the world rather than hiding behind dark glasses.
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[Figure 1], [Figure 2], [Figure 3], [Figure 4], [Figure 5], [Figure 6]