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Made available in DSpace on 2022-04-29T08:36:53Z (GMT). No. of bitstreams: 0 Previous issue date: 2021-01-01 Objectives The aim of this study was to verify during facial expressions (happy, sad, fearful, angry, surprised, and disgusted) if: (1) there would be difference in the electromyography (EMG) of the occipitofrontalis, temporal, masseter, and sternocleidomastoid muscles on the normal side (NS) compared with the affected side (AS) (without the use of an ocular prosthesis) in individuals with unilateral absence of the eyeball, and (2) the rehabilitation with a new ocular prosthesis would affect the EMG of the muscles studied on the AS in these individuals. Materials and Methods Thirteen individuals, without temporomandibular disorder, with good health, with unilateral absence of the eyeball (the eye must have been removed by evisceration or enucleation), and users or nonusers of an ocular prosthesis were included. EMG of the occipitofrontalis, temporal, masseter, and sternocleidomastoid muscles was performed during rest and facial expressions (happy, sad, fearful, angry, surprised, and disgusted) before (T0) and 90 days after (T1) rehabilitation with a new ocular prosthesis. The analyses were performed in T0 on NS and AS (without the use of an ocular prosthesis), and in T1 on AS with the new ocular prosthesis. Statistical Analysis All data were submitted to the Student's t -test with p < 0.05. Results There was no statistically significant difference comparing the AS with the NS in T0 for all muscles studied, during all facial expressions evaluated (p > 0.05). There was no statistically significant difference comparing the AS in T0 with itself in T1 for all muscles studied, during all facial expressions evaluated (p > 0.05). Conclusion Eye loss did not affect the EMG of studied muscles when comparing NS with AS (without the use of an ocular prosthesis). The rehabilitation with ocular prosthesis was not capable of changing the EMG on AS. Department of Dental Materials and Prosthodontics Araçatuba Dental School São Paulo State University, José Bonifácio Street, 1193, Araçatuba Oral Oncology Center School of Dentistry São Paulo State University, Araçatuba Department of Pediatric and Social Dentistry School of Dentistry São Paulo State University, Araçatuba Department of Dental Materials and Prosthodontics Araçatuba Dental School São Paulo State University, José Bonifácio Street, 1193, Araçatuba Oral Oncology Center School of Dentistry São Paulo State University, Araçatuba Department of Pediatric and Social Dentistry School of Dentistry São Paulo State University, Araçatuba

The aim and objective of this article is to analyze the published literature on the replacement time of ocular prostheses in children. A systematic search of Indexed English literature up to November 31, 2020, was conducted. Data from PubMed, Scopus, and Cochrane library were searched for relevant manuscripts. Predefined inclusion and exclusion criteria were used by assessors, who inspected 910 manuscripts and selected 7 manuscripts, after analyzing their full texts. Because of the constant growth of the orbital socket in children, the ocular prosthesis has to be replaced till the growth of the orbit is complete. Custom ocular prosthesis requires recurrent relining or replacement, in growing children. The rate of relining or replacement of the prosthesis varies according to the growth of the orbit. Children with ocular prostheses should be appointed biannually or quarterly for routine examination. Yearly replacement or relining of the prosthesis should be conducted. Various factors, like patient comfort, age, signs, and clinical assessment, should be evaluated before relining or replacing the old prosthesis. How to cite this article: Jain S, Idris KIA, Al Omar NEM, et al. Replacement Time of Custom Ocular Prosthesis in Children: A Review Article. Int J Clin Pediatr Dent 2021;14(4):558–561.

Purpose: To assess clinical and biomolecular changes of the conjunctival epithelium in anophthalmic patients wearing an ocular prosthesis. Methods: Thirty-five unilateral anophthalmic patients were enrolled. Patients with blepharitis, lid abnormalities, and topical/systemic medication affecting the ocular surface were excluded. Symptom Assessment in Dry Eye (SANDE) questionnaire and tear function test (Schirmer Test Type I) were recorded. Conjunctival inflammation and meibomian gland dysfunction (MGD) were graded in the anophthalmic side and fellow eye. Impression cytology sampling of the upper, lower tarsal, and posterior/bulbar conjunctiva from the anophthalmic socket were collected and compared to healthy controls. Results: Patients had significantly higher SANDE ( p < 0.001), Schirmer I test ( p = 0.004), conjunctival inflammation ( p < 0.001), and MGD scores ( p < 0.001) on the anophthalmic side compared to the fellow eye. Mucin 5AC, inflammatory markers (MMP-9, ICAM-1) expression ( p < 0.001), and response to oxidative stress (NRF2-KEAP1 signaling pathway) ( p < 0.05) were significantly upregulated in the posterior conjunctival surface in the anophthalmic socket. Conclusions: Anophthalmic patients complained of more pronounced dry eye symptoms and presented more significant signs of inflammation and MGD on the anophthalmic side. The bulbar conjunctiva, behind the prosthesis, showed more significant hyperexpression of mucins, markers of inflammation, and increased response to oxidative stress compared to the tarsal conjunctiva. Patients wearing ocular prosthesis had signs of inflammation resembling dry eye disease.

It is obvious that a person suffers from severe emotional, social, and psychological trauma when an eye is lost due to any reason. After evisceration, custom made ocular prosthesis can be used to improve facial aesthetics as well as social representation of that person. It is always a challenge to properly fabricate an alternate to the lost eye. But after fabrication, it certainly improves psychological satisfaction of the patient. In this case report, it is attempted to show how a patient was aesthetically rehabilitated with an ocular prosthesis. Key words: Ocular prosthesis, Ocular conformer, Scleral shell.

BACKGROUND: Two patients received ocular injuries from rusted metallic projectiles at their industrial workplaces. Said injuries resulted in the loss of their eyes by evisceration surgeries to prevent fatal infections. CASE DESCRIPTION: The first case, a man in his twenties, received a stock conformer immediately after surgery and started prosthetic therapy within 2 months. The second case, a man in his forties, started prosthetic therapy after 10 years. Definitive custom ocular prostheses were fabricated and relined according to conventional protocol. RESULTS: On issue of the prosthesis, there was adequate retention, aesthetics and stability to extra-ocular movements and treatment was considered successful for both cases. However, follow-ups showed noticeable prosthetic eye movements for case 1 which, to some extent mimicked the physiologic movement of its fellow natural eye. Case 1 adjusted to his prosthesis better while case 2 was still adjusting with little to no physiologic movement. CONCLUSION: Prosthetic rehabilitation should be started as early as possible to obtain optimum rehabilitative results.

The disfigurement caused by loss of any part of the body is often a psychologically damaging experience for the patient. To gain improved fit and intimate tissue adaptation of the prosthesis, an accurate impression and fitting technique is necessary. This article reviews various impression techniques that can be used in clinical practice as and when need arises. Keywords: Nasal prosthesis, Auricular prosthesis, Ocular prosthesis, Orbital prosthesis, Cranial prosthesis.

Background: Management of severely contracted ocular socket with inability to retain ocular prosthesis is one of the most difficult problems to tackle. This study aimed to evaluate feasibility, cosmetic outcome and donor site complications of multistage Mucous Membrane Grafting (MMG) from single donor site. Methods: In this prospective, non-randomized study, 07 patients with severely contracted ocular socket (grade 3-5 Gopal Krishna classification) underwent repair with oral MMG in multiple stages under general anaesthesia. Graft harvested from single donor site from inner aspect of lower lip at every surgery. Subsequent surgery was done 08 weeks later after healing of donor site and reassessment of residual socket contraction. All patients were given customised ocular prosthesis. Patients evaluated for ability to retain the prosthesis and cosmetic outcome. Results: Mean age of patients was 43.5 years. Majority of patients were grade 4 socket contraction. Majority required 2 stages of MMG surgery. While 2 patient required 3 stages of MMG. One patient with grade 5 contraction unable to achieve satisfactory retention of prosthesis even after 3 stages of MMG. Rest all patients had adequate expansion of surface and were able to retain customised ocular prosthesis with satisfactory cosmetic outcome. No patient developed donor site infection or contracture. Conclusion: MMG from single donor site in multiple stages for repair of severely contracted ocular socket is effective technique in terms of ease of surgery, cost effectiveness, ability to retain prosthesis and cosmetic outcome. Keywords: contracted socket, mucous membrane graft, buccal mucosa, ocular prosthesis.

Physical defects which deform the functional activity and appearance that restrict a human-being to lead a normal life, usually attract that person to go under a procedure which can provide a normal life. The disorders involving eye and the orbit that needs surgical interventions that ultimately results in ocular defect, if immediate attention is given after the conservative surgery of the eye or the socket and the conformers are provided still the contractures are seen. The conformers are not given in maximum cases, which causes delayed reduction of space for fabricating ocular prosthesis. An ocular prosthesis is a exact duplication of human anatomical eye by the use of prosthetic materials to generate the illusion of exact healthy normal eye and peripheral tissues. That is why much focus is given to the precise duplication of contour, size and colour that can provide realistic and symmetrical eye to the patients.

Loss of an eye can be physically and psychologically challenging for a patient. The purpose of the ocular prosthesis is to restore the appearance of the lost eye. There are many techniques for iris customisation which can be employed to fabricate the ocular prosthesis. This is a case report where in semi-customized method was employed to fabricate an ocular prosthesis in a simple, fast and satisfactory manner. Keywords: Enucleation ocular prosthesis, Rehabilitation, Semi-customized.

An ocular prosthesis is an artificial eye that replaces the natural eye following an enucleation, evisceration, or orbital exenteration. This maxillofacial prosthesis also boosts the lost social and mental well being of a patient. But, the success of any prosthesis depends upon various factors mainly on the functional recording of the tissue bed the anophthalmus eye. In this case report, a combination of impression technique and procedure is followed to achieve a stable and retentive ocular prosthesis.

A 48 year old physically fit female patient was reported to Department of Prosthodontics with missing right eye. The patient gave a history of infection in the right eye leading to its surgical removal. A custom made artificial eye prosthesis was planned. On clinical examination, the defect site showed no pain and discomfort however, the orbital mucosa of orbit was shrunken.

Phthisis bulbi is an ocular condition caused by wound healing secondary to severe trauma, inflammation, or necrotising tumours of the eye. It represents an ocular endstage disease characterised by atrophy, shrinkage, disorganisation of the eyeball, and intraocular contents. Disfigurement associated with the eye can cause significant physical and emotional disturbance. Prosthetic rehabilitation over the residual eyeball is the preferred treatment of choice over surgical intervention such as enucleation or evisceration. Treatment of such patients is challenging and a multidisciplinary approach is required to provide a satisfactory ocular prosthesis. This case report describes the prosthetic management of a patient with phthisis bulbi by a novel impression-less technique. The initial unsaid communication that takes place between two individuals is through their “eyes”. A confident person will always maintain eye contact while conversing. They are the organs of the visual system which are sensitive to various stimuli.1 Any anomaly involving the eyes causes psychological, emotional, and aesthetic trauma to the patient. Phthisis bulbi is an ocular condition due to multifactorial conditions such as delayed wound healing secondary to severe trauma, infections such as keratitis, uveitis and endophthalmitis. Also, some failed surgical procedures including cataract, glaucoma, retinal surgery and intraocular malignancies like choroidal melanoma, retinoblastoma as well as systemic diseases like diabetes or hypertension may result in phthisis bulbi.2,3 The name “Phthisis bulbi” comes from a Greek word which means “to waste away” or “shrinkage. It is a histopathological diagnosis of end-stage non-functional ocular disease showing atrophy, shrinkage, and disorganisation of the eye and intraocular contents. Clinically, the eyes have no perception of light due to intraocular calcium deposition within band keratopathy, cataractous lens, sclera, gliotic neural retina, or within an optic nerve in the phthisical eye.4 Surgical procedures are not desired in a patient of phthisis bulbi unless it becomes painful. Hence, prosthetic rehabilitation is the only preferred treatment of choice in the patient with phthisis bulbi.5 A properly fabricated custom-made prosthesis enhances the patient's comfort, confidence, and aesthetics by increased adaptiveness, natural appearance, and functional stimulation.6 Hence, we devised an innovative approach to fabricate an ocular prosthesis for a patient suffering from phthisis bulbi by using an impression less technique which has been described in this case report.

Purpose We sought to evaluate the safety and effectiveness of patient-specific ocular prostheses produced by three-dimensional (3D) printing and the sublimation technique. A comparison with prostheses produced using manual manufacturing methods was then performed. Methods To confirm the biological and physiochemical safety, cytotoxicity, systemic acute toxicity, intradermal reaction, and skin sensitization tests were conducted according to the International Organization for Standardization guidelines. The compressive strength of the prostheses was also tested. Further, a case series of three patients who wore the 3D printed prostheses for more than eight hours daily for 4 weeks was executed. Self-assessments by these individuals using a questionnaire and safety evaluations focusing on the occurrence of conjunctival inflammation or allergic reactions according to the Cornea and Contact Lens Research Unit criteria by slit-lamp examination and similarity assessment were completed. Results The 3D printed ocular prostheses met the necessary qualifications per the biological and physiochemical safety tests, showing the absence of cytotoxicity, acute systemic toxicity, intradermal reactivity, and skin-sensitizing potency. Also, there was no difference in strength test results between previous ocular prostheses and the 3D printed ones. Self-assessment by the patients yielded satisfactory results, with no significant difference in the level of satisfaction reported for the 3D printed and previous handmade ocular prostheses. The 3D printed prosthesis did not trigger any side effects in the conjunctival sac and showed similar objective findings with respect to the color of the iris, sclera, and vessel patterns. Conclusions Our study confirms the biologic and physiochemical safety of 3D-printed ocular prostheses created using computer-aided design technology and a sublimation technique. The patients' questionnaires and the judgment of the ophthalmologists/ocularists showed that the 3D printed ocular prosthesis was acceptable in function and appearance through a case series report.

CLINICAL RELEVANCE Loss of an eye has a negative impact on the psychological health of a person. BACKGROUND The aims are to: (a) identify the concerns of experienced prosthetic eye wearers in representative areas of India; (b) investigate how they change over time; (c) study how some demographic characteristics influence concerns; and (d) compare prosthetic eye concerns in India versus Germany and New Zealand. METHODS This observational multi-centre study was conducted in the cities of Mumbai, Bengaluru and Delhi. Subjects aged from 18 to 65-years, with experience of at least two years of wearing a prosthetic eye fabricated from polymethyl methacrylate material, completed a validated questionnaire over the telephone. The questionnaire captured demographic data and general and prosthetic eye concerns at the time of eye loss and at the present time. RESULTS At the time of eye loss, the five main concerns of participants were: health of the remaining eye; change in appearance; comfort; colour of the prosthesis; and movement of the prosthesis. However, after at least two years these concerns were significantly reduced (p

Infants have a preference for watching human eyes compared with other parts of the face and body. At our most instinctual level, humans are hardwired to interpret feelings and understand situations by looking at eyes. When circumstances such as trauma, cancer, or complications related to diabetes warrant the removal of an eye, a crucial part of a patient’s face is lost. Fortunately, there are options that allow patients to regain some sense of normalcy post-enucleation (surgical removal of the eye), but none are ideal. The current standard of care is buying a custom ocular prosthesis, which requires an extensive fitting process. My technical and science, technology, and society (STS) research focus on three different but inherently-related problems related to custom ocular prosthetics. The first problems, addressed in my technical research, are the excessive waste of resources–materials, time, and money– as well as patient discomfort that occurs in the custom ocular prosthesis fabrication process. I propose the use of photogrammetry, a non-contact 3D scanning method, to streamline the fabrication process, reducing the use of resources and mitigating patient distress. The third problem, which is the focus of my STS research, is the exorbitantly high price of an ocular prosthesis, which privileges patients able to afford the high price and marginalizes others. My research seeks to understand the conditions that allow ocularistry to operate as a monopoly and resist updating its technology. Using Actor Network Theory (ANT) as a framework, I will address the roles of the ocular prosthesis, ocularists (the craftsmen who make prosthetic eyes), patients, and sister industry (anaplastology) in creating the current stagnant state of ocularistry. My technical project will explore an alternative ocular prosthesis fabrication process that will optimize resource use and eliminate the need for a painful socket impression to be taken. For the proposed process, the required software and background knowledge is minimal, making it accessible and simple to implement. First, to create an accurate mesh model, images will need to be taken 180° around the front of the face. Tests to optimize lighting, number of photos, and lens type have been performed and will be included in the report. RealityCapture was chosen as the ideal photogrammetry software due to its low cost and ease of use. Once in RealityCapture (optimal settings provided in the report), a mesh model can easily be generated and exported as an object (obj) file to MeshMixer. MeshMixer is used to manipulate the mesh model and determine the shape of the prosthesis. The model is first duplicated, one of which is mirrored so that the non-enucleated eye is on both sides, and the two are aligned. A simple boolean difference returns the shape of the prosthesis based on the missing volume. The method has been verified by artificially enucleating computer-generated imagery (CGI) models using a gaussian function and returning the correct prosthesis size and shape, confirmed using statistical analysis. The final prosthesis will be printed in a biocompatible resin using stereolithography, but that is beyond the scope of the current research. In my STS research, ANT is used to evaluate the factors that contribute to the stagnant state of the ocularistry industry. The first actor, the ocular prosthesis, is highly detailed and accurate, which justifies its pricing. I will include the results of studies on patient satisfaction with their prosthesis to establish the influence of the quality of the prosthesis on the industry as a whole. Secondly, ocularists shape the industry, largely because of trade secrets and lack of oversight from the Food and Drug Administration (FDA). As such, ocularists have the advantage of pricing the prosthesis the way they see fit since so few people know the trade. Thirdly, patients play an important role in allowing ocularistry to thrive; patients face the psychological burden of reestablishing their sense of self, making them more willing to endure the painful and expensive fitting process despite the financial obstacles. This is evidenced by studies on hardships related to adjusting to everyday life that patients face post-enucleation. Finally, the existence of a similar industry called anaplastology influences ocularistry. Unlike ocularistry, anaplastology obtains custom topographical information using 3D scanning devices and is capable of handling more complex eye-related cases, reducing the incentive to update the technology used in ocularistry. In both my technical and STS research, achievements were made to advance the field of ocularistry. Initially, the goal of my technical project was to 3D print a custom ocular prosthesis using the scans from an enucleated patient. Due to the need to adequately verify the accuracy and precision of each step of the process, the goal was changed to producing a custom ocular prosthesis of an artificially enucleated model. With the new goal in mind, my capstone partner and I were able to complete the project. In the future, the process will need to be tested on actual patients with special consideration given to the potential effect of skin tones on the quality of the model. Although, flaws in the method still remain. The method is not effective in patients with two enucleated sockets and may be inadequate in capturing the details of irregularities in the socket. On the other hand, the STS research, which sought to understand the state of ocularistry, was successful in evaluating the four main actors that influenced the industry. To strengthen my STS research, it would have been helpful to obtain more perspectives from ocularists and ophthalmologists in formal interviews. Also, more data is needed on the pricing of an ocular prosthesis to thoughtfully explore the differences that exist within the field. Likewise, the pricing of prosthetic devices made by anaplastologists was omitted in the report, but could provide valuable context and may be helpful to the paper’s argument. Acknowledgements I would like to acknowledge Jaden Stanford, who is my technical project partner, on her equal contribution to the technical work discussed in this paper. Next, Dr. William H. Guilford, who has helped Jaden and me as our technical advisor by giving us feedback at each step in the project and contributing helpful insight throughout the entire process. This project was initially proposed by me during the summer 2021 at the University of Virginia Biomedical Engineering Clinical Scholars program, where contributions were made from faculty member Dr. Brian P. Helmke and biomedical engineering students Piper O’Donnell, Abigail Boitnott, Emily Boland, and Esha Tulsian.

Rehabilitation of an orbital defect is a challenging task, which requires a multidisciplinary approach. The aesthetic and psychosocial impairment associated with ocular defects may cause significant physical and emotional problems. Various treatment modalities are available such as the conventional ocular prosthesis retained by bony and soft tissue undercuts, implant-supported orbital prosthesis etc. Although implant-supported orbital prosthesis encompasses a superior outcome, it may not be advisable in all patients due to economic factors. The present article describes a simplified technique for the fabrication of an interim customized ocular prosthesis that rehabilitates the patient with ideal fit and aesthetics.

Loss of any facial structure can have a deep social, physical and psychological impact on the patient. Rehabilitation of such patients with ocular prosthesis helps to overcome not only their psychological trauma but also social acceptance by restoring the lost facial structure and aesthetics of patient. The present article describes a method of fabricating ocular prosthesis in a single appointment by using conventional materials for acceptable t and optimum aesthetic treatment outcome

Conventional techniques described in the literature for the manufacture of ocular prostheses are time-consuming since they involve manual work. The use of technologies could improve this laborious process, providing better esthetic outcomes. This technique describes how to manufacture the ocular portion of an orbital prosthesis using a smartphone camera, color calibration with a tooth shade guide, and digital printing. This method allows clinicians to fabricate customized ocular prosthesis by using a photograph of the patient's eye, thus eliminating the need for hand-painting and manual work, and reducing fabrication time.

BACKGROUND: This service evaluation explores patient reported outcomes from patients provided with high definition ocular prostheses (artificial eyes). METHODS: Validated patient questionnaires (FACE-Q, DAS24 and HADS) were utilised to evaluate patient experiences of their new ocular prosthesis. 10 patients were included in the service evaluation, which was conducted between December 2018 and September 2019. Descriptive analysis of the mean and 95% CI was undertaken for all questionnaires. Statistical analysis was performed using SPSS 21 Principal Component Analysis (PCA) for FACE-Q questionnaires. Correlations were significant when factor loading is at α > 0.4. RESULTS: A questionnaire response rate of 80% was achieved (n = 8). PCA analysis showed the number of variables tested could be reduced. Two principal components (PC1 and PC2) had very good to excellent internal consistency between variables with factor loading (α = 0.7–0.9). PC1 contained questionnaires 1–7, all of which were highly correlated. PC2 contained question number 8 with a factor loading of α = 0.8. This indicates good reliability, validity and responsiveness. CONCLUSIONS: We hope to demonstrate the importance of service evaluations with respect to rapidly evolving technological advances in medical devices, pharmaceuticals and imaging modalities. Further feasibility and full clinical studies are required to confirm the positive results of the novel artificial eye service we have evaluated with respect to the traditional approach.

Loss of any organ of a body is a traumatising event as it creates functional, esthetics and psychological disharmony in an individual’s life. An ocular defect can be a congenital anomaly or an acquired defect. Rehabilitation of such defect with customized well fitting prosthesis that restores the shape of associated anatomical structures and volume of the socket, not only require an artistic skill but also technical knowledge as every case is unique on its own. The main objective of this article is to describe innovative yet simple technique using NAES ruler for iris selection and fixation of gaze yielding results with utmost patient satisfaction and acceptance. Keywords: Custom ocular prosthesis, Gaze fixation, Iris selection, NAES ruler

Introduction: Insufficient orbital volume in an anophthalmic socket is a major problem for the placement of an ocular prosthesis. This study reports the outcomes of the use of autologous pericranium graft in association with a large primary or secondary orbital implant in patients with a contracted socket and large orbital volume deficit. Methods: This was a retrospective single-institution study. Participants were 13 patients with contracted socket, volume deficit, and insufficient conjunctiva to cover the new implant divided into two groups, A ( n = 3) and B ( n = 10), according to the baseline condition of the socket. Surgery was primary evisceration (group A only) and placement of a large orbital implant followed by an autologous pericranium graft over the implant (groups A and B). Results: Mean follow-up duration for the patient series was 9.5 months (range 9–24). Complete epithelialization of the pericranium graft was recorded at 47.3 days of follow-up (range 33–67). No cases of implant exposure or shrinkage were noted during follow-up. Main postoperative complications were conjunctival granuloma (five patients, 38.5%), conjunctival seroma (one patient, 7.7%). All patients were satisfied with the aesthetic outcome. Conclusion: Autologous pericranial graft was effective in reconstructing the contracted socket so that the anophthalmic socket could accommodate a larger or secondary orbital implant. The efficacy of this procedure needs to be confirmed in a larger patient series.

Primary goal in successful rehabilitation of a patient with ocular defect is to fabricate a well-fitted ocular prosthesis that mimics the original shape and position of the residual anatomical structures and restores volume of the defective socket. Adequate palpebral opening, iris-scleral visibility, color and size of iris, centering of pupil, shade of sclera, proper fixation of gaze and characterization of prosthesis are the key aspects that deserve meticulous attention. Fixation of gaze and selection of iris size can be achieved by various techniques. Four techniques involving usage of millimeter markings and numerical values with armamentarium such as spectacles with graphic grid, cassette holder with grid, modified graphic grid ruler, RS-3 Ophthalmic pupil distance meter coupled with digital imaging technique for iris selection are highlighted through these case series. Keywords: Gaze, Digital iris, Pupil Distance Meter, Graphic Grid.

Aim. To determine the optimal shape of the locomotor stump and the configuration of the corresponding ocular prosthesis, ensuring their maximum motility in patients with anophthalmia with different methods of eye removal. Materials and methods. The study group consisted of 132 patients aged 1880 years after enucleation or evisceration. Examination methods included medical history; examination of eyelids, measurement of length and width of the palpebral fissure, as well as of the depth of conjunctival fornices on both sides; assessment of the volume, shape, surface topography, position and excursions of the locomotor stump, of the protrusion of the ocular prosthesis compared to the contralateral eye; photo registration of the studied parameters. Results. During the study, there were 3 types of locomotor stump identified: moderate with retraction in the upper third; voluminous flattened; voluminous hemispherical. The locomotor stump after enucleation was voluminous flattened or moderate with retraction in the upper third. The best motility of the locomotor stump was noted nasally and downward. The motility of the ocular prosthesis was 47.4% compared to the contralateral eye. The locomotor stump after evisceration with keratectomy was voluminous hemispherical or voluminous flattened. Its motility in all four directions was about the same. The motility of the ocular prosthesis in comparison to the contralateral eye was 55.9%. The locomotor stump after evisceration without keratectomy was voluminous hemispherical, uniform, smooth. The motility of the locomotor stump was maximal in comparison to other groups and relatively equal in all four directions. The motility of the ocular prosthesis in comparison to the contralateral eye was 68.2%. Conclusion. The optimal shape of the locomotor stump, providing the greatest motility of the ocular prosthesis is voluminous hemispherical. The same protrusion of the eyeball and that of the cosmetic prosthesis relatively to the frontal plane after enucleation is achieved by increasing the thickness of the prosthesis itself, which reduces its motility. Evisceration with implantation of the orbital prosthesis involves the use of a thin-walled ocular prosthesis, the back surface of which ideally repeats the locomotor stump surface and does not prevent its maximum motility. When removing a squinting eyeball with preserved corneal diameter, a smaller implant should be used to prevent excessive opening of the palpebral fissure, or to prefer evisceration with keratectomy.

Ocular prosthesis is artificial replacement of the eye, for patients who have lost an eye as result of trauma or a carcinoma. The loss of an eye can have a physical, social, and psychological impact on the affected person. Prosthetic rehabilitation attempts to restore these disfigurements may improve esthetic, level of function, psychological condition of the patient and ultimately ameliorate the quality of life. This article describes clinical report of rehabilitation of a post ophthalmic enucleation patient with custom made prosthesis using stock eye shell that can create esthetically pleasing result. Keywords: Custom-made, Enucleation, Ocular prosthesis.

Eyes are among the first features of the face to be noticed. Loss of an eye due to congenital, traumatic, or pathologic etiologies causes disfigurement and loss of sensory feedback. It leaves a psychological impact on the patient; thus, prosthesis should be provided at the earliest to raise the spirits of the afflicted. Iris positioning is one of the important steps in fabricating customized ocular prosthesis. In facial asymmetry cases, comparison of both irises together can be a major disadvantage. This case report illustrates the use of a regular eyeglass in one technique and the use of a bioart facebow in the second technique for centering of iris in a customized ocular prosthesis to overcome the disadvantages of earlier used standard techniques (McArthur’s ocular locator and fixed calliper, pupillometer, visual judgement, and graph grid) of iris centering.

Purpose To investigate whether impaired lacrimal pump function is a possible cause of discharge in patients wearing an artificial eye compared with the remaining healthy eye. Methods Consecutive patients wearing unilateral ocular prosthesis for ≥6 months were included in this retrospective study. Excluded were any deformities of eyelids or nasal passage, socket complications such as entropion, ectropion, ptosis, infection, pyogenic granuloma, contracted socket, obstruction of nasolacrimal duct diagnosed with lacrimal irrigation and a difference greater than 2 mm in terms of protrusion between two eyes detected by Hertel exophthalmometry. Patients were asked to score the levels of tearing and mucopurulent discharge between 0 and 5 to assess lacrimal drainage function subjectively. Furthermore, dacryoscintigraphy was performed to assess the functional status of the lacrimal system objectively. Results Included were 32 subjects (12 females, 20 males; aged 32.94 ± 17.62, range 13-78). Mean duration of prosthetic wearing 26.41 ± 21.30 (6-72) months. The mean subjective scores of tearing and mucopurulent discharge were 1.56 ± 1.67 and 1.94 ± 1.63, respectively. The rate of functional stenosis was significantly higher in the anophthalmic socket side as compared to the healthy side (P = 0.002). The rates of a presac, preduct, and intraduct obstruction was notes as n = 9, n = 10, n = 1 and n = 0, n = 6, n = 2 in the anophthalmic side and the companion eye, respectively (P = 0.021). Conclusion Compared to paired healthy eyes, the ocular prosthesis exhibited significantly higher rates of functional lacrimal duct obstruction, especially at the presac level. The alterations in orbital volume and tear film composition in addition to reduced corneal reflex blinking may lead to the failure of lacrimal pump function in artificial eyes.

The disability associated with the loss of an eye can cause significant physical, psychological and emotional disturbances. A maxillofacial Prosthodontist can boost the physical and psychological well being of such patients by restoration of functional and esthetic requirements. A 30 year old male serving soldier who sustained a blast injury to the left eye during a counter insurgency operation in the northern sector of the country was referred to Department of Prosthodontics for prosthetic rehabilitation of missing left eye. A custom made heat polymerized polymethyl methaacrylate ocular prosthesis was fabricated for the patient which restored normal opening of the eye, some degree of movements and esthetically pleasing appearance. Keywords: Ocular defect, Custom ocular prosthesis.

An ocular prosthesis is a simulation of human anatomic eyeball to create an illusion of a normal healthy eye and surrounding structures. So the perfect replication of colour, contour and size of the contralateral eye is essential to provide realism and symmetry for the patient. In addition, precise recording of the anopthalmic socket is also essential for the proper retention and form of prosthesis. This article aims to describe the prosthetic rehabilitation of two patients after enucleation surgery with custom made ocular prosthesis. Keywords: Anopthalmic socket, Enucleation, Eye prosthesis, Ocular defect, Ocular prosthesis

Aim An apparatus named "laser pointer apparatus" is proposed for accurate iris positioning in a prosthetic eye. Background Loss of an eye leads to significant psychological stress due to functional disability and societal response to the facial disablement. Custom-made eye prosthesis is a good option to rehabilitate such defects. Inaccurately positioned iris in a prosthetic eye results in squint eye appearance leading to poor esthetics and poor psychological impact among such unfortunate patients. Technique A new apparatus called a laser pointer apparatus, which is an assembly of an occlusal plane analyzer, web camera, laser pointer, and software, has been introduced for iris positioning in a prosthetic eye. Conclusion Iris positioning is one of the key steps in fabricating an eye prosthesis. Laser pointer apparatus is a reliable method for iris positioning in a prosthetic eye. Clinical significance Positioning the iris to the ideal symmetrical position is a cardinal step in the fabrication of an ocular prosthesis. This article aims to introduce a "laser pointer apparatus" to orient iris in a prosthetic eye objectively to overcome the subjective errors.

Purpose: Recurrent contracted sockets are complex situations where previous surgeries have failed, disabling the wear of an ocular prosthesis. A combined method of surgery and long-term fixation using custom-made, three-dimensional (3D) printed conformers is evaluated. Methods: Retrospective case series of nine patients with recurrent excessive socket contraction and inability to wear a prosthesis, caused by chemical burns ( n = 3), fireworks ( n = 3), trauma ( n = 2) and enucleation and radiotherapy at childhood due to optic nerve glioma ( n = 1) with three average previous socket surgeries (range 2–6). Treatment consisted of a buccal mucosal graft and personalized 3D-printed conformer designed to be fixated to the periosteum and tarsal plates for minimal 2 months. Primary outcome was the retention of an ocular prosthesis. Secondary outcome was the need for additional surgeries. Results: Outcomes were measured at final follow-up between 7 and 36 months postoperatively (mean 20 months). Eight cases were able to wear an ocular prosthesis after 2 months. Three cases initially treated for only the upper or only the lower fornix needed subsequent surgery for the opposite fornix for functional reasons. Two cases had later surgery for cosmetic improvement of upper eyelid position. Despite pre-existing lid abnormalities (scar, entropion, lash deficiency), cosmetic outcome was judged highly acceptable in six cases because of symmetric contour and volume, and reasonably acceptable in the remaining two. Conclusions: Buccal mucosal transplant fixated with a personalized 3D-designed conformer enables retention of a well-fitted ocular prosthesis in previously failed socket surgeries. Initial treatment of both upper and lower fornices is recommended to avoid subsequent surgeries for functional reasons.

A 67-year-old Caucasian male presented with severe contraction of socket lining 8 years after enucleation, dermis fat graft and successful ocular prosthesis fitting. Following two failed attempts at using amniotic membrane grafts to reform the socket lining, a total socket reconstruction was attempted using a novel nasal turbinate mucosal graft technique. This was performed in a staged fashion with lower fornix reconstruction followed by upper fornix reconstruction 3 months later. The patient was stable at 12 months review, with a satisfactory cosmetic outcome. Nasal turbinate mucosa was used as it was surgically accessible, provided natural socket lubrication due to its mucosal surface, and avoided oral mucosa and its associated morbidity. This case report suggests that nasal turbinate mucosa is a suitable autologous grafting material for total socket reconstruction in contracted anophthalmic sockets.

Background. Eyes are an important component of the face and vital organs of vision. Eye loss can be caused by congenital defects, trauma, or tumor. Loss of an eye produces physical abnormalities that pose a psychological burden on the patient, as well as visual function damage. An ocular prosthesis is an artificial maxillofacial prosthesis to replace the lost eye. Case summary. A 54-year-old man consults at the Prosthodontics Specialist Universitas Airlangga Dental Hospital for an eye prosthesis. The patient did not have the right eyeball since birth. Soft tissue around the eye is normal, including the palpebral muscles. Case management. An impression was made using a custom tray and alginate in the defect area, followed by filling the impression with gypsum type 3 to get a working model, from which a wax model is made and adjusted to the patient. After that, sclera and ocular acrylic prostheses are made on the basis of an adjusted wax model. The prosthesis is then polished and colored according to the contralateral eye. Then the prosthesis is delivered to the patient. Conclusion. The hollow custom-made eye prosthesis can be considered in the treatment of anophthalmia. It is able to improve the patient's psychological and emotional status.

The successful rehabilitation of the ocular defect with a prosthesis will improve physical & emotional status of the patient. This article describes the rehabilitation of an ocular defect with a custom-made eye prosthesis using graph grid for the proper orientation of the iris.

The use of eyelid switch flap in the correction of lower eyelid coloboma in a post-traumatic contracted socket is described. The lower eyelid, inferior fornix and lateral canthus were successfully created in a single stage with a switch flap from the upper eyelid. A satisfactory cosmetic outcome and a stable fornix for placement of a custom ocular prosthesis was achieved.

Made available in DSpace on 2022-04-29T08:32:39Z (GMT). No. of bitstreams: 0 Previous issue date: 2021-01-01 Background: Ocular prosthesis rehabilitation has an important social, psychological, esthetic, and functional role. Congenital factors, trauma, and tumors, among others, can cause anophthalmia, and it is essential to identify the etiology to guide its prevention and treatment. Methods: The aim of this study was to retrospectively investigate the records of patients treated from 2013 to 2020 by the Oral and Maxillofacial Prosthesis Group, aiming to identify the prevalence of patients with anophthalmia and the etiology of their anophthalmia. After approval by the Human Research Ethics Committee, two calibrated researchers evaluated 520 records, identifying those from patients with anophthalmia. The inclusion criteria were records with complete and legible information from patients with anophthalmia and a description of their etiology. Descriptive statistics were performed, and etiological factors were categorized into trauma, congenital cause, end-stage eye disease, and tumor. Spearman's correlation was performed to verify the relation between gender and anophthalmia etiology, with a 5% significance level. Seventy-two records were included in the study. Results: It was observed that 33.4% of patients were women and 66.6% were men. The etiologies were physical trauma (52.4%), tumor (21.8%), end-stage eye disease (16.6%), and congenital cause (9.2%), and there was no correlation between gender and these etiologies (p =.301). Conclusion: Most of the cases identified were of traumatic origin, which allows the establishment of preventive and educational measures to avoid new cases of anophthalmia. Department of Dental Materials and Prosthodontics Aracatuba Dental School Sao Paulo State University (UNESP) Department of Dental Materials and Prosthodontics Aracatuba Dental School Sao Paulo State University (UNESP)

Loss of an eye can be caused by cancer, trauma, or congenital defects. The rehabilitation of an ocular defect can be done by using a stock prosthesis or by customising a prosthesis for the patient. A prosthesis fabricated by customisation offers more advantages than a stock prosthesis. A custom ocular prosthesis is fabricated by taking an impression of the socket and the tissue bed and allows better contouring of the prosthesis. Hence a custom prosthesis provides a better fit by positive adaptation to the tissue bed, is more comfortable to use and it also gives better cosmetic results compared to a stock eye prosthesis. Hollowing out the prosthesis further increases the patients comfort and adaptability. The main objective of this chapter is to describe a technique for fabricating a hollow ocular prosthesis with the help of a soap spacer.

An ocular defect may follow removal of a part or an entire orbit that results in visual impairment as well as esthecially and psychologically handicapped. Loosing eye is trauma not just to the patient but also for the family members. Restoring an ocular defect bring backs esthetics but also the confidence that has been lost. Rehabilitation is also very important as this also preserves the contour of remaining structure. Different materials can be used for ocular defects rehabilitation like silicone or acrylic. This is a case report of a patient with a ‘pthisicial eye’ and mainly focussed on the fabrication of an ocular prosthesis. Keywords: Enucleation, Ocular, Prosthesis, Scleral Shell.

Loss of the facial structures can have a psychological, physical and social impact on those affected people. The aim of the maxillofacial prosthesis is to inhance the patient aesthetics, restore and maintain health of the remaining structures and also provide physical and mental well being. Multidisciplinary approach is required to rehabilitate the ocular defect patients, which may involve psychologist, ophthalmologist and maxillofacial prosthodontics. Fabrication of ocular prosthesis with custom made approach is highly positive, logical, noninvasive, and beneficial approach for ocular trauma patients. Ocular prosthesis helps the patient psychologically as well as esthetically. So, in this case series fabrication technique of ocular prosthesis is described in two cases of traumatic enucleation of eye. Keywords: Ocular prosthesis fabrication technique trauma.

The loss of an eye is an emotional and psychological setback to the patient. An ocular prosthesis is given to uplift the patient psychologically and to boost up patient’s self esteem and their social acceptance in the society. To improve the comfort and matching of the prosthesis with that of the adjacent natural eye a custom made ocular prosthesis is preferred. Ocular prosthesis can be given as stock eye shell or by fabrication of custom-made eye prosthesis by sclera painting. Advantages of custom-made eye prosthesis are well established over stock eye shell so, this article presents a case report of a patient-wearing stock eye shell with poor esthetics, and the same was replaced with custom-made eye prosthesis. Keyword: Pthisis bulbi, Custom made ocular prosthesis.

The loss of an eye creates huge psychological impact on individual’s social and professional life. When surgical procedures like enucleation and evisceration removes the soft tissue contents of defective eye, abnormally large defect is created. The prosthetic rehabilitation of such large defect is always a challenge, which demands exactly matching, closely fitting, equally sized ocular prosthesis to replace lost tissue volume. This article attempts to present an innovative technique to fabricate an aesthetically superior hollow ocular prosthesis exactly matching with the natural eye of the patient. Key Messages: Although there are various methods to fabricate hollow ocular prosthesis, utilizing silicon putty index and modelling wax and Anterior Segment Camera for iris selection is a simple and innovative technique which provides superior aesthetic and better comfort. Keywords: Ocular defect, Hollow ocular prosthesis, Digital iris, Anterior segment.

Eye is a vital organ not only for vision but it is also important component of facial expression. The disfigurement associated with loss of eye can cause significant physical and emotional problem. There are several techniques documented in the literature for fabricating the artificial eye. This is a case report of fabricating ocular prosthesis with stock iris and custom made sclera to provide aesthetically satisfactory result and better fit.

Objective:This case report describes the rehabilitation process of a case of acquired eye defect with patient specific or custom made ocular prosthesis for a patient who had her left eye surgically enucleated as a treatment step for retinoblastoma. Method: After primary evaluations, an intraorbital impression was taken while reproducing natural eye movements to ensure accuracy of the impression. The impression was cast and a transparent acrylic conformer was made from the mould in the cast. The conformer was adjusted as required and Iris position determined. The conformer was then used to cast the final custom ocular prosthesis. The patient was then instructed on its usage and maintenance. Result: A custom made ocular prosthesis was provided to the patient and it was to her satisfaction. Conclusion: Custom made ocular prosthesis is highly recommended in rehabilitation of facial defects of a co-operative patient as it does not have most of the limitations which a stock ocular prosthesis does. Bangladesh Journal of Medical Science Vol.18(4) 2019 p.823-826

Ocular defects result from tumor, congenital anomaly, external injury or the need for histologic confirmation of a suspected diagnosis not only lead to serious impairment of function and esthetics but also make the patient psychologically handicap. Prosthetic rehabilitation attempts to restore these disfigurements may improve esthetic, level of function, psychological condition of the patient and ultimately ameliorate the quality of life. This article describes clinical report of rehabilitation of a post ophthalmic enucleation patient with custom made prosthesis using stock eye shell that can create esthetically pleasing result. Although the patient cannot see with this prosthesis, it will definitely restore the patient’s self?esteem and allow him or her to confidently face the world rather than hiding behind dark glasses Keywords: Custom made, Enucleation, Rehabilitation.

A permanent orbital implant is highly required to support ocular tissues after surgical removal of patient’s eye during an ocular disease treatment. We therefore study the feasibility to use egg shell waste for producing biomedical porous glass–ceramic orbital implants. A biocompatible porous glass–ceramic implants were prepared from egg shell-based calcium-silicate glasses by foam replication method. The egg shell-derived glass–ceramic implants obtained a pure biocompatible CaSiO3 phase at 1100 °C. In comparison to the glass–ceramic implants from a commercial CaCO3, the egg shell-derived glass–ceramic implants contained an open-macropore network with porosity over 30% allowing the fibrovascular tissue ingrowth. The glass–ceramic implants derived from egg shells had good chemical stability in simulated body fluids (2-weeks in vitro test). Therefore, this new porous glass–ceramic material is a promising alternative low-cost biomedical implant for ocular prosthesis applications.