Posts Tagged ‘scleral shells’

Tears in the Artificial Eye Socket

Wednesday, October 16th, 2013

Coating the inner and outer surfaces of the artificial eye is a tear film. People normally blink the eyelids about every six seconds to replenish this tear film. Tears have four main functions on the artificial eye:

  • wetting the conjunctival lining of the socket, preventing damage due to dryness,
  • creating a smooth optical surface on the front of the microscopically irregular acrylic surface,
  • providing lubrication and acting as a vehicle to remove debris from the prosthetic surface, and
  • containing an enzyme called “lysozyme” which destroys bacteria.

The tear film resting on the prosthetic surface has three layers:

  • Lipid layer,
  • Aqueous Layer, and
  • Mucin Layer.

The top layer of the tear film is the lipid or oily layer. This layer prevents the aqueous layer beneath it from evaporating, as well as preventing the tears from flowing over the edge of the lower eyelid.

Below the lipid layer is located the aqueous layer of the tear film. This middle layer is the thickest of the three tear layers. The aqueous fluid contains salts, proteins and lysozyme.

The bottom layer is the mucin layer. This layer adheres to the “hydrophobic” (water-repelling) acrylic surface of the prosthesis. Therefore, for a tear layer to be able to remain on the prosthetic surface without rolling off, the “hydrophilic” (water-attracting) mucin layer is necessary.

A deficiency of any of the three layers of the tear film can lead to a “dry eye” condition, causing anything from mild eye irritation to severe pain. Interestingly, in some cases, excessive tearing or watering of the eyes can be a symptom of a dry eye condition. This is because when, for whatever reason, there is an inadequate normal tear layer on the eye, irritation results; the latter causes an overproduction of the lacrimal gland and a flooding of lacrimal fluid into the eye.

Besides excessive tearing, symptoms associated with dry eyes can include the following:

  • eye irritation, scratchiness, grittiness, or pain,
  • redness of the conjunctival tissue,
  • a burning sensation in the eye,
  • a feeling of something in the eye,
  • eyes that feel “glued shut” after sleeping,
  • excess mucosal drainage, and
  • discomfort wearing the prosthesis.

There can be multiple causes of a dry eye condition for a prosthetic eye wearer:

  • lid or blinking problems,
  • reading or working at a computer screen for long periods of time,
  • medications like antihistamines, oral contraceptives, beta blockers, diuretics, tranquilizers, pain relievers, or antidepressants,
  • a dry climate (including heating and air conditioning in a home, airplane, or hotel room), wind, UV radiation, tobacco smoke, and dust,
  • diseases such as rheumatoid arthritis, Sjogren’s syndrome, keratoconjunctivitis sicca, xerophthalmia, lupus erythematosus, Grave’s disease, diabetes, or scleroderma
  • hormonal changes accompanying menopause,
  • chemical, radiation, or thermal burns to the eye,
  • vitamin A deficiency,
  • aging, since the tear glands produce fewer tears as we age,
  • protein adhesion to prosthetic surface,
  • scratches on the prosthetic surface, or
  • ill-fitting prosthesis.

A dry eye problem often can be relieved with the use of lubricating eyedrops, which are instilled daily or as needed onto the prostheic surface. These types of drops can soothe the socket, moisturize dry spots, supplement tears, and protect conjunctival tissue from further irritation. They provide comfort and a nice shiny, even tear layer over the prosthesis. They have a higher viscosity than natural tears, so they need to be insilled less frequently, often just once or twice per day. The lubrication allows for easier blinking, less drainage from the socket, and a very natural appearance.

Soothing eye drops are also available. These drops have the same viscosity as natural tears, which means they will not be as long lasting as the lubricants, but they do have soothing properties to control allergies, discomfort, itchiness, inflammation and excess mucosal drainage.

Some patients chose to try “artificial tears” type eyedrops to alleviate the sypmtoms of dry eye. These are not very successful because they do not last very long. Most “artificial tear” drops only contain saline, which evaporates very quickly. Some eyedrops contain “vasoconstrictors” (chemicals such as tetrahydrozaline or naphazoline), which constrict the conjunctival blood vessels, thereby reducing the amount of redness on the surface of the eyes. We do not recommend these drops for prosthetic eye wearers as they damage the tissue lining the anophthalmic socket.

Should you have any difficulty with your current regimine, we recommend working with your Ophthalmologist, Optometrist and your Ocularist to determine the root of your symptoms and come up with an appropriate solution. With a healthy fit of your prosthesis, frequent polishing and proper lubrication, your prosthesis should be able to fit and function well. Our goal is to provide our patients with excellent comfort and cosmesis for the most natural, realistic result possible.

Soothing Eye Drops for Artificial Eyes

Wednesday, May 29th, 2013

Soothing eye drops can be indispensable for the comfortable wearing of an ocular prosthesis. These drops are not specific to prosthetics, but they work very well to alleviate dry, tired, allergy symptoms.

An anophthalmic socket is similar to a sinus. Often patients report that their sockets react first when they contract a cold or sinus infection. When irritation occurs or when their allergies flare up, soothing eye drops will be very helpful in calming the fragile conjunctival tissue. Ease your discomfort by matching your most common symptoms with the drops below.

Similasan drops have been used by our patients with very good success. These soothing drops provide lubrication and their specific soothing properties. Choose from Dry Eye Relief, Allergy Eye Relief and Computer Eye Relief.

Many of our patients have found great success combining 1-2 drops of an artificial tear with one drop of Sil-Ophtho or Ocu-Glide, to provide an instant tear film and instant relief.

Similasan Dry Eye Relief #1Similasan Allergy Eye Relief #2Similasan Computer Eye Relief #3

Montana Girl’s Cancer Battle Provides Inspiration

Friday, May 4th, 2012

Brynn PuleCheck out this story on KTVQ in Billings, Montana about Brynn Pule – certainly one of the cutest little ladies we know! What a delight that this family can share their struggles to encourage others. Thanks Brynn!

If you have a story that you would like to share, contact us and we would be happy to post it here.


American Society of Ocularists Meeting in Seattle

Wednesday, April 6th, 2011

This weekend, the American Society of Ocularists is holding their semi-annual educational meeting in Seattle, Washington. This will be the first time the ASO has met in Seattle and it proves to be an exciting line-up of speakers and programs. Two of our distinguished eye physicians will be speaking at the conference.

Bryan Sires, MDBryan Sires, MD, PhD, FACS from Allure will be speaking on the anatomy and physiology of eyelids.

Abstract: The specialized anatomy of the eyelid provides the physiological benefits to the eye. The eyelid is paramount in protecting the eye and enhancing vision. This comes about by the function of eyelid opening and closure along with the production of tears for the visual medium. A thorough understanding of normal eyelid anatomy and physiology allows one to appropriately examine this structure. Deviations from normal allow one to understand diagnostic entities and to provide the basis for treatment.

Avery Weiss, MDAvery Weiss, MD, from Seattle Children’s will be speaking about ocular diseases in infants and children.

Abstract: This lecture will focus on congenital abnormalities of the globe in which the services of an ocularist are frequently needed. The first portion of this talk will focus on postnatal growth of the eye and orbit, ocular malformations with emphasis on microphthalmia, anophthalmia and glaucoma. The second portion will focus on acquired diseases of the globe especially intraocular tumors, retinal vascular diseases, retinopathy of prematurity and trauma for which enucleation is a treatment option. The main goal of this lecture is for the ocularist to learn more about the ocular diseases in infants and children that may benefit from orbital expanders and ocular prosthetics.

Common Questions About Artificial Eyes

Friday, March 5th, 2010

Often we will receive questions that may be helpful to other wearers of ocular prosthetics, or for one who is in need of an artificial eye. We hope these questions and answers below will be helpful!

Q: Will the eye “cry” like normal?
A: Yes, the tear production is in the eyelids, so having a prosthesis bring the eyelids forward to “full sized” will allow normal tear production and tear flow.

Q: Can you “rub” your eye, get the sleep out of it?
A: Yes, we recommend patients rub both eyes “towards the nose” to remove any drainage or sleep in the eye.

Q: Is it sensitive to hot and cold temperatures. Below zero weather?
A: The prosthesis itself is solid acrylic, so it does not conduct heat. If you are skiing in cold and wind, the eye will become cold and dry quickly. If you are in a hot dry or dusty environment, it will become dry quickly. Both of these extreme environments can be alleviated by using a lubrication eye drop to keep the eye moist and lubricated. We have several types of lubricants that have worked well for patients.

Q: In the winter cold on a walk, will the eye drain fluid?
A: Similar to above, it may become dry and the body may try to lubricate, so it may drain, similar to tears. Again, using a lubrication drop before the walk will alleviate this.

Q: Will sleep/drainage in the eye be bad?
A: In the prosthetic side, typically more drainage is produced due to the presence of the prosthesis in the socket. Whether this will increase or decrease the amount of drainage you currently experience is difficult to predict.

Q: Will it pop out involuntarily?
A: In general, no. The prosthesis is held in by the eyelids, so if your lower lid is very lax, it would be more possible for the prosthesis to become dislodged when rubbed. For most, this is not a concern.

Q: Are there any activity restrictions?
A: No. Swimming is fine, chlorine will not damage the prosthesis. I can not think of any other activities that would be hampered by wearing a prosthesis.

Q: Can I take a normal shower?
A: Absolutely.

Q: Can you wear make up near the eye?
A: Absolutely.

Q: What happens when the eye socket becomes infected?
A: Infection would be noticeable by increased drainage or discomfort in the socket. Treatment would be similar to pink eye, treated with an antibiotic gel or eye drop. It should clear on its own, just like pink eye would, but will clear within 2-3 days with an antibiotic.

Q: Are the procedures done at your office?
A: Yes, the entire prosthesis is made over 4 appointments at our office.

If you have questions that are not answered here, feel free to contact us! We would be happy to help in any way we can. Also, take a look at our Frequently Asked Questions.

Help! My Dog Ate My Eye!

Monday, November 16th, 2009

It may sound funny, but this has happened to several patients over the years. Just as animals like the smell and taste of your shoes, they will happily munch on your prosthetic eye if it is left unattended. We would typically recommend wearing your eye full time, but if you need to remove it for any reason, make sure you store it in a safe place, out of the reach of any of your four footed friends.

This is an example of a recent occurrence, note the small bite marks that cover the front and back surface. This may seem hopeless, but if the acrylic is not too old, we may be able to grind through the marks, add back the acrylic and return the prosthesis to its original condition.