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Table of Contents
CASE REPORT
Year : 2018  |  Volume : 5  |  Issue : 3  |  Page : 39-43

Ocular prosthesis: A case report


1 PG Student, Department of Prosthodontics, Crown and Bridge, Divya Jyoti College of Dental Sciences and Research, Modinagar, Uttar Pradesh, India
2 Professor, Department of Prosthodontics, Crown and Bridge, Divya Jyoti College of Dental Sciences and Research, Modinagar, Uttar Pradesh, India

Date of Web Publication30-Jan-2019

Correspondence Address:
Dr. Mohit Bhatnagar
Department of Prosthodontics, Crown and Bridge, Divya Jyoti College of Dental Sciences and Research, Modinagar, Uttar Pradesh
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/INPC.INPC_5_18

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  Abstract 


The human eye is one of the most important features of facial esthetics. The loss of an eye can have debilitating effects on the patient's physical, social, psychological, and overall mental attitude toward life. Loss of eye can be a result of enucleation, evisceration, or exenteration procedures to treat any underlying etiology. As a result, there is a dire need for an ocular prosthesis after the surgical procedures. Different materials and procedures can be used for the fabrication of an ocular prosthesis. This case report presents the fabrication of a semicustomized ocular prosthesis using a stock iris shell.

Keywords: Custom ocular tray, enucleation, evisceration, exenteration, semicustomized ocular prosthesis


How to cite this article:
Bhatnagar M, Tomer L, Arti, Hussain W, Sharma P, Markose GM. Ocular prosthesis: A case report. Int J Prev Clin Dent Res 2018;5:39-43

How to cite this URL:
Bhatnagar M, Tomer L, Arti, Hussain W, Sharma P, Markose GM. Ocular prosthesis: A case report. Int J Prev Clin Dent Res [serial online] 2018 [cited 2019 Dec 6];5:39-43. Available from: http://www.ijpcdr.org/text.asp?2018/5/3/39/251052




  Introduction Top


A missing organ can result in severe effects on one's psychology, especially when it is a vital part of one's appearance. A missing eye invariably leads to physical, social, and psychological changes in a patient's way of thinking and self-confidence. Loss of a human eye can be a result of surgical procedures such as enucleation, evisceration, or exenteration which are aimed at treating malignancies, congenital defects, sympathetic ophthalmia, irreparable trauma, underlying infections, phthisical eye, etc.

Enucleation refers to a complete removal of the globe along with a part of optic nerve and may or may not involve musculature. Evisceration, on the other hand, is a more conservative procedure that involves the removal of the intraocular contents of the globe, sometimes the cornea.[1]

The enucleation procedure is commonly done under general anesthesia, but can be performed under local anesthesia with a retrobulbar block.[2],[3] To reduce the risk of some remaining cancerous tissue, a large portion of the optic nerve is also removed in some cases.[4] However, there can be a significant risk of ptosis and extraocular muscle damage accompanied with this procedure because the optic nerve is transected near the orbital apex. In evisceration, the internal aspect of the sclera is cauterized and treated with absolute alcohol to denature any residual proteins, decreasing the risk of sympathetic ophthalmia.[5]

Orbital exenteration is a more radical procedure, and it implies the removal of the orbital contents including the periorbita and eyelids. However, sometimes, orbital tissue can be conserved, and eyelid skin and orbicularis muscle are spared. Exenteration surgery is necessary in cases of orbital and periorbital tumors, and occasionally other conditions, that are potentially fatal malignancies.[4]

Various methods and techniques have been used to fabricate a prosthesis that replaces the human eye. The following report highlights the use of a custom ocular tray and a stock iris shell to fabricate a semicustomized ocular prosthesis.


  Case Report Top


A 51-year-old female patient reported to the Department of Prosthodontics, Crown and Bridge, Divya Jyoti College of Dental Sciences and Research, Modinagar, with a complaint of a missing eye for 2 years that was a result of enucleation to treat varicella infection that spreads to the eye [Figure 1]. On further history taking, the patient revealed that she had been wearing a stock scleral shell for 4 months, but it was not satisfied in terms of the fitting. On examination of the socket, no signs of infection or inflammation were seen, and there was a healthy conjunctiva. The movements were satisfactory sideways and downward, but were not as satisfactory in the upward direction.
Figure 1: Preoperative

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A semicustomized ocular prosthesis was planned using a stock iris shell and a custom made sclera and a custom-made ocular tray. The patient was thoroughly educated about the whole procedure.

Procedure

  1. The stock scleral shell was duplicated into a custom ocular tray [Figure 2] made of clear acrylic autopolymerizing resin (DPI RR Cold Cure, Dental Products of India), and a needle cap was attached to facilitate the injecting of light-body consistency of polyvinyl siloxane (PVS) material (Aquasil, Dentsply) during impression making
  2. The custom ocular tray was tried in the patient's ocular cavity [Figure 3], and any irregularities and interferences in movements were trimmed
  3. The eyelids were applied with petroleum jelly before making the impression
  4. Impression was made by placing the PVS light-body impression material (Aquasil, Dentsply) into a disposable syringe (Dispovan) and injecting it into the already-placed ocular tray in the orbit [Figure 4]. The patient was asked to make movements during the procedure that led to a functional impression
  5. After the material was set, it was taken out and examined [Figure 5] for any air bubbles or irregularities, after which it was poured into dental stone [Figure 6] (Kalabhai Kalstone, Kalabhai Karson Pvt. Ltd.)
  6. A counter die was poured after the initial set of the first pour and application of separating medium (DPI Ltd.) [Figure 7]
  7. Molten modeling wax (DPI Ltd.) was poured into the sprue which was formed by the syringe cap, and this led to the fabrication of wax pattern [Figure 8] and [Figure 9]
  8. Size, shape, and color of a stock iris were selected according to the contralateral eye
  9. This was sealed on to the wax pattern using a heated instrument after trimming the necessary portions and was tried into the patient's ocular cavity. Position of the iris was finalized according to the contralateral eye using a vernier caliper. Any changes in fullness were done [Figure 10]
  10. The shade of the sclera was selected in accordance with the natural contralateral eye
  11. The patient was asked to perform upward, downward, and lateral movements and any overextensions were removed [Figure 11]
  12. Flasking and dewaxing were done and packing was done into the prepared mold using selected shade of heat-cured acrylic resin (DPI-heat cure, DPI Ltd.) and a long curing cycle was followed [Figure 12]
  13. The final prosthesis obtained after deflasking was trimmed with an acrylic trimmer followed by finishing and polishing of the prosthesis. The prosthesis was inserted into the patient's ocular cavity. Stability, contour, and positioning of the iris were examined once again, and characterization of the prosthesis was done by trimming acrylic resin of sclera to a depth of 1 mm and the prosthesis was delivered. Red-colored nylon fibers were placed to the outer periphery to simulate blood vessels and stabilized using cyanoacrylate adhesive
  14. Trimmed sclera was replaced with a clear heat-cured polymerizing acrylic resin, and curing, deflasking, finishing, and polishing were done [Figure 13] and [Figure 14].
Figure 2: Custom ocular tray

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Figure 3: Tray trial

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Figure 4: Petroleum jelly

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Figure 5: Light body functional impression made

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Figure 6: Impression

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Figure 7: Two piece cast with sprue

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Figure 8: Molten wax flowed into cast

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Figure 9: Wax pattern

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Figure 10: Measuring distance of pupil from the central reference point

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Figure 11: Wax try in

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Figure 12: Separating media

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Figure 13: Packing

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Figure 14: Final Prosthesis

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The final ocular prosthesis was delivered and postinsertion instructions were given regarding the usage and maintenance [Figure 15].
Figure 15: Post operative

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  Discussion Top


Customized ocular prosthesis has the advantages over stock eyes such as better contouring, color matching, and coordinated movements with the contralateral eye.[1] Customizing the iris demands extra skill and time from the operator.[6] This can be avoided if stock iris matching with the contralateral natural eye is available. Semicustomizing the prosthesis using the stock iris and customized sclera will have advantages of both stock and custom prosthesis. This technique is not advised when the color, contour, and configuration of the stock iris are not satisfactorily matching with the contralateral natural eye of the patient.[1]


  Conclusion Top


A semicustomized ocular prosthesis has been described that reduces the fabrication time by selecting a matching stock iris while a custom-made sclera maintains the esthetics properly. This prosthesis enhances the patient's comfort and confidence by increased adaptiveness and natural appearance and also maintains its orientation when the patient performs various eye movements.

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

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
Putanikar NY, Patil AG, Shetty PK, Nagaral S, Mithaiwala HI. Prosthetic rehabilitation of a patient with ocular defect using semi-customized prosthesis: A Case report. J Int Oral Health 2015;7:81-4.  Back to cited text no. 1
    
2.
Moshfeghi DM, Moshfeghi AA, Finger PT. Enucleation. Surv Ophthalmol 2000;44:277-301.  Back to cited text no. 2
    
3.
Morton A. Enucleation and evisceration. In: Thach AB, editor. Ophthalmic Care of the Combat Casualty (Textbooks of Military Medicine). Washington, DC: Office of the Surgeon General at TMM Publications; 2003. p. 405-20.  Back to cited text no. 3
    
4.
Singh KR, Chaurasia S. Ocular implants and prosthesis. DOS Times 2014;20:55-62.  Back to cited text no. 4
    
5.
Chin M, Marques C, Danz H. Ocular prosthesis: Indications to management. Can J Optom 2015;77:24-32.  Back to cited text no. 5
    
6.
Sykes LM. Custom made ocular prostheses: A clinical report. J Prosthet Dent 1996;75:1-3.  Back to cited text no. 6
    


    Figures

  [Figure 1], [Figure 2], [Figure 3], [Figure 4], [Figure 5], [Figure 6], [Figure 7], [Figure 8], [Figure 9], [Figure 10], [Figure 11], [Figure 12], [Figure 13], [Figure 14], [Figure 15]



 

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