Prosthetic Eye Research Articles

Eye Mapping: Innovative Technique for Precise Iris Positioning in Prosthetic Eye.

The aim of this technique is to institute "Augmented Reality Tool" in the field of maxillofacial prosthesis for an accurate and precise iris positioning in a prosthetic eye. A congenital defect, irreversible damage, a painful blind eye, sympathetic ophthalmia, or the requirement for histological confirmation of a suspected illness can all result in the absence or loss of an eye. In such circumstances, meticulous preoperative, surgical, and prosthetic planning using a multidisciplinary approach is imperative for successful rehabilitation. Augmented reality filter was used to provide precise mapping of facial landmarks and to aid in iris positioning. Smartphone device (S22) was used and artificial intelligence (AI)-generated Instagram application was unfurled and augmented reality (AR) filter was instituted. The filter available in the application made it possible to see and confirm the iris shell's location in three dimensions from various angles. The dimensions thus provided, aided in the correct positioning of the iris in the prosthetic eye. Iris positioning stands as one of the crucial steps in fabricating a patient-specific ocular prosthesis. In the present case report, iris positioning was done using AI has provided an excellent esthetics results and patient compliance was met with satisfaction. Accurate positioning of iris can be done using AR tool which is popular, easily accessible, less technique sensitive, and can be performed with slightest efforts in small clinical set-ups. Relating to patient, it is comfortable, economic, and trouble-free procedure. How to cite this article: Zilpilwar NR, Nimonkar SV, Chitlange P, et al. Eye Mapping: Innovative Technique for Precise Iris Positioning in Prosthetic Eye. J Contemp Dent Pract 2024;25(7):711-714.

Tear secretion is preserved while the area of meibomian glands is reduced in patients with prosthetic eyes, contributing to the symptoms of dry eye

Background/aimsIt is unclear whether a reduction in tear secretion contributes to the discomfort experienced by those with prosthetic eyes. Tear secretion has hitherto only been measured with the Schirmer test...

CUSTOMISED OCULAR PROSTHESIS FABRICATION - A CASE SERIES

Loss of an eye, whether due to trauma or medical necessity, can lead to significant physical and psychological distress This article delves into the profound impact of ocular prosthetics in alleviating the physical and psychological repercussions of eye loss. Acrylic resin has been identified as an optimal material for its durability, aesthetic fidelity, and biocompatibility in fabricating ocular prostheses. Beyond restoring facial symmetry and enhancing aesthetics, these prostheses significantly bolster patient self-confidence and overall quality of life. The series comprehensively examines four distinct methods for iris positioning and prosthesis characterization, crucial for imparting natural vitality to the prosthetic eye. Each case underscores the importance of personalized care in ocular prosthetics, emphasizing the advantages over standard stock prostheses.

The current alternative for ocular surface and anophthalmic socket reconstruction, cryopreserved umbilical amniotic membrane (cUAM).

This report presents the results of using cryopreserved umbilical amniotic membrane (cUAM) as an alternative mucosal graft for ocular surface reconstruction in cases of anophthalmic socket contracture (ASC), cicatricial entropion (CE), and conjunctival-scleral defects. The study included patients who underwent non-commercial implantation of cUAM grafts (prepared by corneal banking methods) for ASC, CE, conjunctival defect, and scleral melting. The main success criteria for this study were the comfortable fitting of the ocular prosthesis in ASC patients, the natural eyelid position in CE patients, and the degree of conjunctivalisation in melting patients. cUAM transplantation was performed in 2 patients who could not use a prosthetic eye due to conjunctival contracture, 2 patients with CE, and 1 patient with conjunctival defect and 1 patient with conjunctival-scleral melting. The primary outcome was achieved in 83.3% (5/6) of patients. In one patient with CE, partial healing was achieved due to the persistence of CE in the medial upper eyelid. cUAM is a viable alternative to mucosal grafting for reconstructing the bulbar and palpebral conjunctival surface, fornix, and orbit, with reduced donor morbidity and shorter surgical time. Its regenerative ability allows for tissue defect healing and improves cosmetic appearance through epithelialization within weeks.

Clinical Results of Prosthetic Eye Wear in Patients with Congenital Microphthalmos

Purpose: To report the long-term clinical outcomes of non-surgical treatment involving prosthetic eye wear in patients diagnosed with congenital microphthalmos.Methods: A retrospective review of the medical records of 20 patients was conducted. In total, 21 eyes were diagnosed with congenital microphthalmos between May 2008 and December 2022 at Seoul St. Mary’s Hospital in Korea.Results: This study included 20 patients (12 males and 8 females) with an average age of 4 months at diagnosis. The observed ophthalmic anomalies included two cases of congenital cataract, one of posterior embryotoxon, one of corneo-iris strand, four of iris coloboma, five of central corneal opacity, one of Peter's anomaly, and one of retrobulbar cyst. Accompanying systemic abnormalities were noted, such as lateral ventricle atrophy, corpus callosum atrophy, patent ductus arteriosus, atrial septal defect, and developmental language disorder. Genetic anomalies included anti SS-A/Ro antibody positivity, a 1:100 titer of anti-nuclear antibody, and a PAX6 mutation identified through next-generation sequencing. No specific family histories or pregnancy-related factors were noted. The average follow-up duration was 5.94 years (range: 1 month to 18 years), the average corneal diameter was 4.6 mm, the average axial length was 17.44 mm, the average age for first artificial eye trial was 5.96 years (range: 7 months to 19 years), and the average interval for artificial eye replacement was 22 months (range: 4 months to 5 years and 8 months).Conclusions: Twenty patients with congenital microphthalmos underwent gradual expansion of their prosthetic eyes by regular replacement and size increase without severe complications. This approach led to aesthetically and emotionally positive outcomes for the patients.

Living with an artificial eye: qualitative insights into patient and family member experiences.

Artificial eye users (AEUs) can experience a negative impact on psychological and emotional wellbeing, including reduced social functioning, which may be a consequence of living with one eye removed, and/or of having a prosthetic eye. This may have wider consequences for their families. We aimed to explore what it means to live with a prosthetic eye, for both AEUs and their families-and how any quality of life (QoL) issues impact on their day-to-day functioning. A subset of AEUs and their family members taking part in a feasibility randomised controlled trial comparing hand-painted to digitally printed artificial eyes were invited for semi-structured interviews. Transcripts were analysed using reflexive thematic analysis. Qualitative results related to trial participation are covered elsewhere. Here, we focus on QoL and day-to-day functioning. Twelve AEUs (eight males) and five spouses (one male) who had worn artificial eyes for 2-65years took part, and four themes were identified. (1) Impact on day-to-day life: AEUs and their spouses have to adapt to (partial) sight loss, reduced levels of confidence, and social withdrawal. (2) Impact on psychological and emotional wellbeing: distress among AEUs and their spouses can be severe and prolonged, highlight unmet support needs. (3) Challenges with treatment experiences: AEUs experienced negative impact of fragmentation of care and long waiting times. (4) Worries about the future: AEUs mentioned fragility of remaining sight, and concerns around potential need for further treatment. Patients and their family members experience negative impact of being an AEU on their everyday lives and quality of life. There is a potential role for psychosocial support services in supporting AEUs and their families even long after eye loss.

Advances in Microvascular Reconstruction of the Orbit and Beyond: Considerations and a Checklist for Decision-Making.

This paper aims to discuss the microvascular reconstruction of the orbit and adjacent regions and to propose a checklist to aid the reconstructive surgeon in this challenging undertaking. The discussion is based on a literature review that includes 32 retrospective case series, 5 case reports published in the last 34 years in PubMed, and 3 textbook chapters. Additionally, it relies on the senior author's expertise, described in a case series, and two case reports published elsewhere. Classifications and treatment algorithms on microvascular orbit reconstruction generally disregard patient-related factors. A more holistic approach can be advantageous: patient-related factors, such as age, comorbidities, prognosis, previous interventions, radiotherapy, and the wish for maximal dental rehabilitation and a prosthetic eye, have the same importance as defect-related considerations and can inform the choice of a reconstructive option. In this manuscript, we examine defect- and patient-related factors and new technologies, provide a checklist, and examine future directions. The checklist is intended as a tool to aid in the decision-making process when reconstructing the orbital region with microvascular flaps.

NAVIGATING MODERN LIVING THROUGH ADVANCEMENTS IN MOBILE SERVICES AND BIOELECTRONIC MEDICINE

Technology is tightly interwoven with our surroundings, becoming a crucial aspect of our existence. The iPhone, emblematic of technological progress, continually evolves, introducing enhancements in mobile apps, GPS, and cashless payment systems like Ola Cab and Uber. These advancements address challenges like locating reliable taxis swiftly. Bioelectronic medicine, a recent breakthrough, relies on electrical pulses instead of traditional drugs. Implanting small electronic devices generates digital doses, treating conditions like epilepsy and Parkinsons disease. This approach, synonymous with electroceuticals and neuromodulation, leverages the inflammatory reflex theory to map neural circuits. Despite its potential, challenges exist, including maintaining glycemic control and prosthetic eye usage.

A challenging diagnosis of narcolepsy type 2 in a patient with Duane syndrome

Duane syndrome is a form of congenital strabismus with horizontal eye movement limitation. This may present a diagnostic challenge when assessing for rapid eye movements during stage REM utilizing PSG or MSLT. We present a case of a child with Duane syndrome who presented with excessive daytime sleepiness and underwent evaluation for hypersomnia. His eye movement limitation provided a challenge in identifying stage REM. In patients with eye movement limitations or prosthetic eyes, it is necessary to look for other features of stage REM such as low chin EMG tone and EEG pattern.

Cuttlefish: Pushing the Limits of Graphical 3-D Printing.

This article presents Cuttlefish, a 3-D printer driver developed at the Fraunhofer Institute for Computer Graphics Research IGD. Cuttlefish maximizes the reproduction quality of shape and appearance in multimaterial 3-D printing systems. It controls various printing systems and material sets, including color, transparent, and flexible materials. The article provides an overview of Cuttlefish's graphical 3-D printing pipeline and focuses on its unique features: Displaced signed distance fields for robust voxelization of objects not designed for 3-D printing, joint color and translucency reproduction, accurate color and translucency characterization, shape dithering to eliminate quantization-based staircase artifacts, and support for displacement maps and constructive solid geometry operations. The article concludes by showcasing applications of Cuttlefish in printing replacement faces for stop-motion animation, large-scale figurine production, and prosthetic eye printing.

Non-fabricated ocular prosthesis posteviseration

Eyeball loss is a traumatic process as it can cause functional, media, psychological and aesthetic problems. Patients who re-quire treatment with specialised eye prostheses are those who have lost ocular structures through removal of orbital contents or orbital enucleation to accelerate physical and psychological healing and improve aesthetics. This article reports the fabrication of an eye prosthesis as a rehabilitative treatment in a patient who had undergone orbital enucleation. A 38-year-old man came to RSGMP Universitas Hasanuddin Makassar referred by an ophthalmologist with complaints of left eyeball loss due to trauma. The patient wanted to have a prosthetic eye made immediately to restore his appearance and self-confidence. Examination of the eye socket showed a healthy conjunctiva and no infection. The treatment was the fabrication of a non-fabricated eye pros-thesis made from acrylic resin. The fabricated non-fabricated eye prosthesis had advantages in terms of retention, stability, aes-thetics and patient comfort. It was concluded that the ocular prosthesis can reduce the psychological trauma caused by the loss of the eyeball, thus increasing the patient's confidence in social life.

ASSOCIATION BETWEEN VISUAL STATUS OF REMAINING EYE, EMOTIONAL WELL-BEING AND SOCIAL FUNCTIONS IN A SAMPLE OF ANOPHTHALMIC PATIENTS IN MALAYSIA – A PILOT STUDY

This study aims to investigate the relationship between the visual status of the remaining eye, emotional well-being and social functions in anophthalmic patients using a validated questionnaire. Anophthalmic patients aged 18 years and above who visited the optometry clinic in Universiti Kebangsaan Malaysia, Kuala Lumpur, for prosthetic eye fitting participated in this study. Refraction and visual acuity (VA) of the remaining eye were examined using subjective refraction and the Snellen chart, accordingly. The National Eye Institute’s 25-item Visual Functions Questionnaire (NEI VFQ-25) was used to determine the emotional well-being and social functions of the patients. The results were analysed using the Pearson chi-square model. A total of 23 patients participated in this study, with 52.2% of them being emmetrope, 30.4% myope and 17.4% hyperope. Their mean VA was 6/6. The mean score of NEI VFQ-25 was 67.8 ± 2.8 (score ranged: 47.5 to 93.5). The analysis revealed significant reduction in NEI VFQ-25 score for all patients [95% CI: 64.22 to 74.44, p = 0.04]. However, there is no significant association between VA of the remaining eye and the NEI VFQ-25 score (p=0.24). This study concludes that the emotional well-being and social functions of the anophthalmic patients is low, but the score is not associated with the visual status of the remaining eye.

Ocular Prosthesis: A Next Generation Cosmetic Management by an Eye for an Eye

An ocular prosthesis is an artificial eye that replaces an absent natural eye following an enucleation, evisceration or orbital exenteration. The prosthesis fits over an orbital implant and under the eyelids that covers the structures in the eye socket. It is a non-optical device designed only to improve the cosmesis of an individual with anophthalmic socket or disfigured eye. A normal facial appearance is one of the inherent human traits, if any changed or lost challenges physical, social, mental well-being, self-confidence and psychological influence on the affected people. The loss of an eye is a severe psychological trauma with negative impact on the quality of life of the patient. It is quite challenging to restore the normal look of the patient for bringing him to normality in society. In this view, an ocular prosthetic eye helps to improve the quality of life, satisfaction and appearance of affected eye to any injury or disease of the patient. It is given to uplift the patient’s behavioral, mental status and improve the confidence especially in children. Today, most artificial eyes are made of medical grade plastic acrylate (polymethyl methacrylate material) with an average life of about 2-3years depending upon the way that people use it. It is commonly known as “Device or Scleral Shell or Glass Eye or Fake Eye”. The children require more frequent replacement of the prosthetic eye due to rapid growth changes in the eye. The construction of an ocular prosthesis in the case of congenital and acquired anophthalmia differs in etiology but many concepts of management for a child are the same as for an adult. An early intervention with ocular prosthesis can stimulate orbital growth and prevent facial asymmetry.

The Impact of Prosthetic Eye Shell on the Quality of Life of Anopthalmic Patients; Questionnaire Based

The Impact of Prosthetic Eye Shell on the Quality of Life of Anopthalmic Patients; Questionnaire Based

Prosthetic approach following traumatic evisceration: a case report

A 20-year-old male patient was referred to Prosthodontic Department, Dental Hospital of Hasanuddin University, Makassar with chief complaint of disfiguration of the face. Medical history revealed a significant trauma to the left eye 6 months prior which stayed after evisceration. Patient has never used prosthetic eye afterwards. Examination of the left eye socket revealed a healthy conjunctiva covering the posterior wall of the anophthalmic socket with syn-chronous motions and absence of infection or inflammation signs. Sulcus depth was sufficient enough to retain prosthetic eye. This article presents rehabilitation of the ocular defect with customized acrylic-based ocular prosthe-sis to increase patient’s appearance and to prevent further shrinkage of the eye socket. Preliminary impression was done using customized tray fabricated from modelling wax and hydrocolloid irreversible impression material. An in-traocular custom tray for secondary impression was fabricated with acrylic resin and modified with a syringe that at-tached to the custom tray. Secondary impression of the defect was recorded using polyvinyl siloxane light viscosi-ty material followed by wax pattern fabrication using modelling wax. The wax pattern was tried in patient’s socket and checked for size, comfort, support, fullness, and then packed with tooth colored heat cure acrylic resin. After deter-mining the location and diameter of the iris with an optical vernier pupillary distance ruler, the color of sclera was de-termined by shade guide and confirmed with technician using digital photo. Ocular prosthesis was fabricated after-wards and inserted into the eye socket and evaluated for suitability, aesthetic and also movements with the contra-lateral eye. It is concluded that customized ocular prosthesis was significantly more aesthetic than pre-fabricated one with better contouring, color matching, and coordinated movements with the contralateral eye. This prosthetic ap-proach may restore patient’s appearance, increase their self-esteem, and improve their quality of life.

A rare case of severe bilateral Graves' orbitopathy involving an anophthalmic socket.

This is a report of a rare case of Graves' hyperthyroidism associated with severe bilateral Graves' orbitopathy, in a patient with an anophthalmic eye socket. On clinical review her prosthetic eye (left eye) was tilting upwards, along with worsening of Graves' orbitopathy (GO) in the only seeing eye. As she refused IV glucocorticoids, she was offered rituximab which only caused a transient improvement in the clinical activity score of the eye. She had persistent right upper lid retraction of 6 mm, associated with lagophthalmos. To protect her seeing eye from corneal ulceration, the patient received a botulinum toxin injection to the right upper eyelid to induce blepharoptosis as an interim measure prior to right upper eyelid blepharotomy in April 2021. This patient remains biochemically euthyroid on block and replace therapy and her TRAb level is falling over time. Treatment for active GO is ongoing and the patient required a redo blepharotomy for painful corneal exposure in the right eye. Graves' orbitopathy (GO) does not actually primarily affect the eyeball itself but the orbital contents as well. Patients with severe GO in an only seeing-eyed patient should be referred early to a multidisciplinary Joint Thyroid Eye clinic for expert review and management. Patient outcomes including sight loss are likely to be improved by the extended range of medical and surgical treatment modalities available at specialist clinics treating GO, including the use of immunomodulatory drugs like rituximab or teprotumumab.

Health Literacy in Patients Wearing Prosthetic Eyes: A Prospective Cross-Sectional Study

Purpose To investigate general and electronic health literacy (HL) levels in prosthetic eye wearing patients, to define factors associated with reduced HL, and to identify a potential healthcare gap. Methods In this prospective cross-sectional study 148 prosthetic eye wearers were screened using the 16-item European Health Literacy Survey Questionnaire (HLS-EU-Q16) and the 8-item electronic Health Literacy Scale (eHEALS). HLS-EU-16 and eHEALS scores were correlated to health levels, vision functioning, and sociodemographic factors. Results A total of 85 patients (57%) had adequate, 38 (26%) problematic, and 9 (6%) inadequate general HL, while 16 (11%) had no valid HLS-EU-Q16 score. General HL was positively correlated with physical health (p = 0.009) and negatively with a migration background (p = 0.023). There was a positive correlation between electronic HL and educational level (p < 0.001), social status (p = 0.048), and mental health (p = 0.013). Higher age was associated with lower electronic HL (p < 0.001). Conclusions More than 30% of the prosthetic eye wearers had problematic or even inadequate general HL, suggesting a significant health care gap. To identify patients with reduced HL, a standardized screening tool should be implemented as part of routine clinical care. Within integrated care, patients with insufficient HL should be offered barrier-free advisory services and information brochures in various languages.

Motility of the Ocular Prosthesis in Anophthalmic Patients: Objective and Patient-perceived Findings

ABSTRACT Aim To study the impact of the prosthesis motility on the Quality of Life (QoL) in anophthalmic patients. Methods Cross-sectional, observational study of 100 anophthalmic patients, of whom 64% had an acryl implant, 6% an Allen implant, 1% a hydroxyapatite implant, 4% a dermis fat graft, 16% no implant, and 9% an unknown implant. We quantitatively assessed the motility of the prosthesis with Kestenbaum glasses and the QoL with a validated questionnaire covering five domains: General functional abilities and care, wearing comfort, physical appearance, psychological and social functioning. Associations between measured prosthetic eye motility, patient-perceived motility, and satisfaction were made. Results Motility of the prosthesis was impaired with an average loss of 76%, and correlated with Cosmetic satisfaction (adduction P = .02, abduction P = .008, elevation P = .04) and Social satisfaction (adduction P = .03, abduction P = .003). The patient-perceived motility of the prosthesis correlated with General functioning abilities (horizontal P = .0004, vertical P = .0004), Comfort (horizontal P = .001, vertical P = .003), Cosmetic satisfaction (horizontal P = .0002, vertical P = .0002), Psychological satisfaction (horizontal P = .001, vertical P = .001), and Social satisfaction (horizontal P = .002, vertical P = .003). Conclusions Ocular prosthetic motility has a significant impact on patient-perceived satisfaction and physical appearance, and predicts coping with the prosthetic condition on the psychosocial level. This highlights the need of introducing patient-reported outcome measures in the prosthetic rehabilitation of the anophthalmic patient.

The Ruptured Globe, Sympathetic Ophthalmia, and the 14-Day Rule.

Prophylactic enucleation of a ruptured globe with no light perception within 14 days of injury to prevent sympathetic ophthalmia (SO) has been an established dictum in academic teaching for more than 100 years. This treatment strategy was originally based on observation, speculation, and careful thought, but there was never any scientific proof. This review summarizes and updates the current state of our knowledge about globe rupture and SO, examines the origin and validity of the 14-day rule, and emphasizes the importance of trying to save the traumatized eye whenever possible. A comprehensive literature review of SO and globe rupture was performed. SO is a rare disorder that may potentially occur following traumatic globe rupture as well as following a variety of other intraocular surgeries. Vitreoretinal surgery may be a more common cause than trauma according to some studies. SO may still occur despite having the eye removed within 14 days of the trauma. A variety of new medications including biologic agents are now available to treat SO with improved efficacy in suppressing the associated ocular inflammation and allowing retention of some useful vision. Removing the traumatized, blind eye may have other important psychological consequences associated with it that require consideration before eye removal is carried out. Retaining the blind, phthisical, disfigured eye avoids phantom vision and phantom pain associated with enucleation as well as providing a good platform to support and move an overlying prosthetic eye. Data on the occurrence of SO following evisceration and enucleation with and without predisposing factors confirms the exceedingly low risk. Most civilian open globe injuries can be successfully repaired with modern, advanced microsurgical techniques currently available. Because of the exceedingly low risk of SO, even with the severity of open globe trauma during military conflicts being more devastating as a result of the blast and explosive injuries, today every attempt is made to primarily close the eye rather than primarily enucleate it, providing there is enough viable tissue to repair. The 14-day rule for eye removal after severe globe ruptures is not scientifically supported and does not always protect against SO, but the safe time period for prophylactic eye removal is not definitively known. In the exceptional cases where SO does occur, several new medications are now available that may help treat SO. We advocate saving the ruptured globe whenever possible and avoiding prophylactic enucleation to prevent the rare occurrence of SO. When an eye requires removal, evisceration is an acceptable alternative to enucleation in cases that do not harbor intraocular malignancy.

Adhesive Retained Ocular Prosthesis - “Correcting Defects Providing Quality Life”: Clinical Case Series

Ocular defects are usually due to maxillofacial trauma. This causes an alteration of facial appearance and aesthetics. Apart from psychological trauma to the patient, it interferes with the normal life. Hence correcting such defects with prostheses can get back the individual to normal social life. A prosthetic eye is an answer for these defects. It can help in improving the appearance of the defective eye socket Even though it cannot restore vision, it gives normal appearance for the patient and mental support to a great extent. Adjusting to the ocular prosthesis can be really challenging both mentally as well as physically. This article describes the fabrication of custom-made ocular prostheses retained by adhesives in a series of cases where patients have lost their eyes due to trauma. Keywords: Eye prosthesis, Ocular Prosthesis, Custom eye prosthesis, Adhesive retention.