About Prosthetic Eyes and Scleral Lenses
When an eye has been enucleated (fully removed) or eviscerated (inner contents and cornea) the fitting of a prosthetic eye or scleral lens is then required.
In situations where the eyeball has become diseased, disfigured, shrunken and unsightly, a scleral shell prosthesis or a prosthetic contact lens is the best option to improve and restore natural appearance and eye lid function.
The development of more complex vitreoretinal, glaucoma, corneal surgical techniques has meant that more eyes are being saved (some with useful vision and others without sight) and that more patients are spared the potential need of eye removal. The retained eye provides a good foundation for scleral shell prostheses or prosthetic contact lenses, and these offer more natural movements with the companion eye.
Typically, there is better orbital symmetry, motility or “movement” and less secretion or discharge of the scleral shell compared to having the eye totally removed. With a diagnosis of eye cancer or choroidal melanoma you must have an enucleation-an evisceration is not an option.
It is recommended that you wear your prosthetic eye during your everyday activities, including sleep, showers, and during sports like skiing and swimming (eye protection is a must)!
Your eyes will still cry while wearing a prosthetic eye, since your tears come from your lacrimal glands that are still intact. The lacrimal glands are near your outer eyebrows, through emotions, campfire smoke or onion fumes the tears are triggered and travel through ducts in the upper eye lids. They drain through tiny ducts near your nose.
Most Provincial and State health care plans cover a large portion of the cost of the orbital implant and artificial eyes and most insurance companies cover the remaining balance of prosthetic eyes as this is a medically prescribed device.
You will have to verify coverage with your Province or State as well as your individual Insurance company policy.
Upon completion of your new custom prosthetic eye, you most likely will have somewhat natural “conversational” darting eye movements. It is very common that most custom artificial eyes and scleral cover shells move better towards the nose.
Extreme gaze movements that are “not typical” as we tend to move our neck will lag somewhat. We advise patients to use their neck to help compensate. We call this “scanning”.
When being seated in a restaurant or theatre try to have your good eye closest to others for more natural vision.
Prosthetic Eyes For Your Natural Appearance
Prosthetic eyes are the best treatment option for someone who has lost an eye. People of all ages and genders are fitted for prosthetic eyes after they have an eye (or in some cases, both eyes) removed due to a traumatic eye injury, ocular disease, diabetes, or facial disfigurement.
The purpose of a prosthetic eye is to create and maintain natural eye lid positions, natural tear production and flow. Also to restore the normal symmetrical appearance of the eyes. Without a well fit custom ocular prosthesis in the eye socket or over a shrunken globe one would experience more drainage, crusting and discomfort as the eye lids and lashes would roll in.
People have been making and wearing prosthetic eyes since the Egyptian era. There is evidence that eyes were made of clay, jewels, painted and attached to a piece of cloth and worn outside the socket.
Many centuries later, people began making and wearing prosthetic eyes from glass. These were dangerous and could break within the socket. They were blown from glass and were not impression fit.
Today, prosthetic glass eyes are no longer fit in North America. They are still made and fit in European countries. Mostly they are mass produced in Germany.
For the past 80 years or so when an eye needs to be surgically removed; an orbital implant is placed within the socket to restore lost volume. Typically, 4 of the 6 ocular muscles are reattached to the orbital implant to offer the best movements possible.
Following an enucleation or an evisceration you will leave the operating room with a thin, curved, typically clear acrylic disk between your eye lids. This is called a conformer and it is very important that it remains in place during the 6-8 week healing process.
The purpose of the conformer is to retain the fornices (pouches) of the eye lids and prevent the inner membranes (conjunctiva) from fusing or scarring to the surface of the buried orbital implant that the surgeon has placed within your orbit. You may also have a stitch holding your eye lids together. It is possible to have a custom conformer complete with an iris, pupil, white, and even blood vessels fit approximately 4 weeks following your surgery.
This should only be fit by an experienced Board Certified Ocularist. At all cost one should avoid any type of “stock” or ready made artificial eye as it may cause damage to your socket/orbital implant that could cause the orbital implant to extrude or break through the tissues. One should research and plan to meet with a prosthetic eye-maker, known as an ocularist prior to the planned surgery if possible.
Be sure that the ocularist is well experienced and is Board Certified.
This will offer you confidence and peace of mind during your healing phase. Should your conformer happen to fall out is not an emergency, but it needs to be disinfected, rinsed and put back in place. If it falls out easily then that is an indication that you will need a custom conformer.
Your final custom ocular prosthesis will have a better “custom impression fit” and a more natural colouring to match your good eye.
Some medical insurance plans cover the costs of a prosthetic eye, or at least part of the costs.
Without insurance, ocularists may charge $2,500 to $8,300 for a custom fit acrylic eye or shell.
The type of orbital implant you choose, the surgery needed to remove your eye and the custom ocular device can be costly without insurance.
Even with insurance, under most plans, you will be expected to pay a fee (copayment) during each visit to your ocularist, surgeon, and doctor.
Be sure to discuss thoroughly with your oculoplastic surgeon prior to your planned surgery, if possible, to have all of your questions answered. Particularly your post operative care and medications. You may experience pain and nausea in the first 72 hours following surgery however your surgeon will probably inject strong pain medication into your orbit to relieve this.
Also discuss the time that you will need to remain in the hospital and the time you will be required to be off work or school.
Remember to never lift anything heavy following your discharge from the hospital and refrain from heavy lifting until advised by your surgeon. Flying may also be advised to avoid until healed. Again, be certain that your medications, bandage care follow up appointments are well planned.
It can take several months and even up to 1 year for total healing.
Typically, your custom ocular prosthesis can be fit at 6-8 weeks following your surgery. Once you have been fit with your custom ocular device you should return to the oculoplastic surgeon and Ocularist at 1 month, 3 month then 6 month appointments to be certain that the socket is healing well and that the custom artificial eye is fitting well.
Following the completion of your new custom ocular prosthesis or scleral shell if for any reason you are not pleased and comfortable you must discuss with your ocularist and oculoplastic surgeon to remedy this.
If this does not satisfy you then by all means get a second or even third opinion.