21-02-2011, 09:23 AM
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The Artificial Eye
We hope this information will help answer any questions you may have regarding artificial eyes. Please feel free to ask any further questions when you see Mr Cheung when you attend the hospital next time. This information sheet is for your general information only and is not intended to be a substitute for a proper consultation by a trained medical professional.
Introduction
This handout is intended to be of use for patients about to undergo or have undergone artificial eye surgery (Evisceration/Enucleation). It refers to the removal of the natural eye (the eye with which you were born) and rehabilitation of the socketto make it look cosmetically pleasing. We understand that the removal of an eye can be emotionally and psychologicallychallenging for a patient. Our aim is help the patient and his or her family come to grips with this difficult stage in their life.For this reason, we have a team professionals who are ready to answer any questions and offer guidance. Please feelfree to contact us to discuss any questions or queries you may have about artificial eye surgery.Note: This handout does NOT refer to the experimental vision systems which are being researched to allow blind orpartially sighted patient to see. It is envisaged that it will be many years before these will be available for generalised use.IndicationsThere are three main reasons why one!s natural eye needs to be removed.1. If the natural eye becomes blind and painful. Its removal can give the patient welcome comfort and relief. This is usually only done when most other treatments have failed2. If the natural eye becomes blind and looks cosmetically poor. For example the natural eye may look very scarred,start to shrink in size and the cornea (clear window at the front of the eye) may turn white.3. If the natural eye becomes dangerous e.g. for cancer of the eye- Is comfortable- Shows good movement- Looks normal to the observer- Is easy to look after
The operationThere are essentially two types of operation for removalof the eye: Evisceration and Enucleation.Evisceration involves removal of the clear window atthe front of the eye (cornea) & the core of the eye.Enucleation- involves removal of the entire eyeball.In both types of operation, the outer coverings of theeyeball are then sutured together, usually to cover anorbital implant, so that the cavity of the socket isshallower and lined with the pink membrane(conjunctiva). Most patients nowadays undergo anevisceration since it is quicker, thought to offer bettermotility and has a lower rate of long term problems.However enucleations are still performed in certain casese.g. for melanoma of the eye, a type of cancer where oneneeds to be sure of complete removal of the entire eye.Although both operations are usually performed undergeneral anaesthesia (patient asleep and ventilated), if theanaesthetist considers that general anaesthesia is toodangerous e.g. if the patient has severe lung or heartdisease, surgery can be performed quite comfortablyunder local anaesthesia, often with a mild sedative torelax the patient
.Early period after surgery
A pressure dressing is applied to the socket for the firstweek to try to reduce the postoperative swelling. Contraryto belief, usually the patient is very comfortableimmediately after surgery. A course of antibiotic tablets isusually prescribed with anti-inflammatory medication(ibruprofen or diclofenac). The patent is then reviewedusually one week after surgery and the dressing isremoved. A clear plastic disc called a conformer is ofteninserted into the cavity of the socket at the time of surgeryto help the socket attain the correct shape.At 6 weeks to 8 weeks, the patient is then usually seenby an ocular prosthetist (sometimes called an ocularist).This is someone who is trained in making artificial eyes.A mould of the cavity of the socket is made so that a newcustom made artificial eye known to match the patient!sother eye can be manufactured. The manufacture of anew cosmetic shell can take a couple of months and aAfter 3 monthsThe patient is advised on how to look after the artificialeye and socket by the ocular prosthetist. It is usuallyadvisable to remove the artificial eye from time to timee.g. at night or weekly and to clean it. Your ocularprosthetist will be able to advise you about this. Somepatients who are uncomfortable with handling thecosmetic shell, may leave the shell in all the time
.Potential complications and problems
The risk of things going wrong with artificial eye surgery isextremely low but as with any type of surgerycomplications and problems can occur.InfectionWith artificial eye surgery, the most serious complicationwhich can happen early on following surgery is infection.This usually responds very well to antibiotics.Implant extrusion/exposureAs stated above an orbital implant is usually implanteddeep into the socket at the time of removing the eye. Themain role of the orbital implant is compensate for the lossin volume from removing the natural eye therefore fillingout the socket so that the cavity of the socket isshallower. This means the artificial eye can be thinnerand lighter, thus allowing better movement and bettercomfort for the patient. Very, very rarely, the orbitalimplant may start become exposed and may even workits way out. This may require further surgery to rectify.Imperfect appearance/comfortThe vast majority of patients are very very happy with theappearance, movement & comfort of their artificial eye.However, a tiny proportion of patients request improvedmotility, a better appearance or greater comfort. This canoften be easily achieved but may require additionalsurgery.Long term changesAfter many, many years of wearing an artificial eye, thepatient!s socket may start to alter slightly sometimesresulting in an imperfect appearance, comfort ormovement of the artificial eye. For example, the artificialeye may start to look sunken, the upper lid may start todroop or the lower lid may start to sag. If the patientwishes, further procedures may be performed to improvematters.
The Artificial Eye
We hope this information will help answer any questions you may have regarding artificial eyes. Please feel free to ask any further questions when you see Mr Cheung when you attend the hospital next time. This information sheet is for your general information only and is not intended to be a substitute for a proper consultation by a trained medical professional.
Introduction
This handout is intended to be of use for patients about to undergo or have undergone artificial eye surgery (Evisceration/Enucleation). It refers to the removal of the natural eye (the eye with which you were born) and rehabilitation of the socketto make it look cosmetically pleasing. We understand that the removal of an eye can be emotionally and psychologicallychallenging for a patient. Our aim is help the patient and his or her family come to grips with this difficult stage in their life.For this reason, we have a team professionals who are ready to answer any questions and offer guidance. Please feelfree to contact us to discuss any questions or queries you may have about artificial eye surgery.Note: This handout does NOT refer to the experimental vision systems which are being researched to allow blind orpartially sighted patient to see. It is envisaged that it will be many years before these will be available for generalised use.IndicationsThere are three main reasons why one!s natural eye needs to be removed.1. If the natural eye becomes blind and painful. Its removal can give the patient welcome comfort and relief. This is usually only done when most other treatments have failed2. If the natural eye becomes blind and looks cosmetically poor. For example the natural eye may look very scarred,start to shrink in size and the cornea (clear window at the front of the eye) may turn white.3. If the natural eye becomes dangerous e.g. for cancer of the eye- Is comfortable- Shows good movement- Looks normal to the observer- Is easy to look after
The operationThere are essentially two types of operation for removalof the eye: Evisceration and Enucleation.Evisceration involves removal of the clear window atthe front of the eye (cornea) & the core of the eye.Enucleation- involves removal of the entire eyeball.In both types of operation, the outer coverings of theeyeball are then sutured together, usually to cover anorbital implant, so that the cavity of the socket isshallower and lined with the pink membrane(conjunctiva). Most patients nowadays undergo anevisceration since it is quicker, thought to offer bettermotility and has a lower rate of long term problems.However enucleations are still performed in certain casese.g. for melanoma of the eye, a type of cancer where oneneeds to be sure of complete removal of the entire eye.Although both operations are usually performed undergeneral anaesthesia (patient asleep and ventilated), if theanaesthetist considers that general anaesthesia is toodangerous e.g. if the patient has severe lung or heartdisease, surgery can be performed quite comfortablyunder local anaesthesia, often with a mild sedative torelax the patient
.Early period after surgery
A pressure dressing is applied to the socket for the firstweek to try to reduce the postoperative swelling. Contraryto belief, usually the patient is very comfortableimmediately after surgery. A course of antibiotic tablets isusually prescribed with anti-inflammatory medication(ibruprofen or diclofenac). The patent is then reviewedusually one week after surgery and the dressing isremoved. A clear plastic disc called a conformer is ofteninserted into the cavity of the socket at the time of surgeryto help the socket attain the correct shape.At 6 weeks to 8 weeks, the patient is then usually seenby an ocular prosthetist (sometimes called an ocularist).This is someone who is trained in making artificial eyes.A mould of the cavity of the socket is made so that a newcustom made artificial eye known to match the patient!sother eye can be manufactured. The manufacture of anew cosmetic shell can take a couple of months and aAfter 3 monthsThe patient is advised on how to look after the artificialeye and socket by the ocular prosthetist. It is usuallyadvisable to remove the artificial eye from time to timee.g. at night or weekly and to clean it. Your ocularprosthetist will be able to advise you about this. Somepatients who are uncomfortable with handling thecosmetic shell, may leave the shell in all the time
.Potential complications and problems
The risk of things going wrong with artificial eye surgery isextremely low but as with any type of surgerycomplications and problems can occur.InfectionWith artificial eye surgery, the most serious complicationwhich can happen early on following surgery is infection.This usually responds very well to antibiotics.Implant extrusion/exposureAs stated above an orbital implant is usually implanteddeep into the socket at the time of removing the eye. Themain role of the orbital implant is compensate for the lossin volume from removing the natural eye therefore fillingout the socket so that the cavity of the socket isshallower. This means the artificial eye can be thinnerand lighter, thus allowing better movement and bettercomfort for the patient. Very, very rarely, the orbitalimplant may start become exposed and may even workits way out. This may require further surgery to rectify.Imperfect appearance/comfortThe vast majority of patients are very very happy with theappearance, movement & comfort of their artificial eye.However, a tiny proportion of patients request improvedmotility, a better appearance or greater comfort. This canoften be easily achieved but may require additionalsurgery.Long term changesAfter many, many years of wearing an artificial eye, thepatient!s socket may start to alter slightly sometimesresulting in an imperfect appearance, comfort ormovement of the artificial eye. For example, the artificialeye may start to look sunken, the upper lid may start todroop or the lower lid may start to sag. If the patientwishes, further procedures may be performed to improvematters.
