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 Table of Contents  
CASE REPORT
Year : 2017  |  Volume : 7  |  Issue : 1  |  Page : 55-57

Prosthetic management of a patient with an ocular defect


Department of Prosthodontics, Bharati Vidyapeeth Deemed University Dental College and Hospital, Pune, Maharashtra, India

Date of Web Publication30-Jun-2017

Correspondence Address:
Ojasvi Nijhawan
Bharati Vidyapeeth Deemed University Dental College and Hospital, Katraj, Pune, Maharashtra
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/ijmd.ijmd_58_16

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  Abstract 

Prosthesis is an artificial substitute that is implanted into or integrated into a human body part to replace the missing natural organ, for the purpose of restoring a specific function or a group of related functions so that the patient may return to normal life as quickly as possible. An eye for an eye is what the old saying goes. The eye plays a vital role as one of the six senses. From vision to expression, it has varied functions. Loss of this organ severely impacts not only the vision but also self-confidence. A case report is presented where a simple technique is used to provide the subject with eye prosthesis as rapidly as possible.

Keywords: Custom–made; enucleation; ocular prosthesis


How to cite this article:
Nijhawan O, Bhide SV, Vasantha N, Kandi N. Prosthetic management of a patient with an ocular defect. Indian J Multidiscip Dent 2017;7:55-7

How to cite this URL:
Nijhawan O, Bhide SV, Vasantha N, Kandi N. Prosthetic management of a patient with an ocular defect. Indian J Multidiscip Dent [serial online] 2017 [cited 2021 Mar 7];7:55-7. Available from: https://www.ijmdent.com/text.asp?2017/7/1/55/209275


  Introduction Top


An ocular prosthesis is a maxillofacial prosthesis that artificially replaces an eye missing as a result of trauma, surgery, or congenital absence.[1] Surgical procedures in the removal of an eye can be broadly classified as: evisceration (where the contents of the globe are removed leaving the sclera intact), enucleation (most common, where the entire eyeball is removed after severing the muscles and the optic nerve), and exenteration (where the entire contents of the orbit including the eyelids and the surrounding tissues are removed).[2] In such cases, artificial eye prosthesis replaces the natural eye in form and esthetics.

The advancement in ocular prosthetics, an ophthalmic patient, can be rehabilitated very effectively. Various methods include, a) stock eye prosthesis (Prefabricated), b) custom-made ocular prosthesis.[3] In this case report, an easy and economical method of fabricating an ocular prosthesis is described.


  Case Report Top


A male patient aged 16 years was referred to the Department of Prosthodontics, and the Department of Ophthalmology, Bharati Vidyapeeth Deemed University Dental College and Hospital, Pune from, for fabrication of prosthesis of left eye following enucleation. The left eyeball was enucleated following penetrating injury due to some road traffic accident about 4 years back.

Clinical and laboratory procedures

  • The patient was seated in the dental chair, and the eye socket was examined. The degree of healing and the existing muscle movements were studied. The amount of adipose tissue remaining and the contour and tonus of the eyelids were examined [Figure 1]
  • The patient was positioned upright in the chair and trained to maintain a fixed gaze on a point directly in front. The eye lashes, eye brows, and the socket surface were lubricated with petrolatum
  • A hollow syringe was loaded with an irreversible hydrocolloid and was placed in the eye socket taking care to avoid entrapment of air [Figure 2]. The patient was asked to do all the functional movements and to stare at a point directly in front
  • After the material was fully set, the impression was removed and poured in type III dental stone using two pour techniques [Figure 3]
  • The special tray was constructed using tray compound, and final impression was made using light body impression material. The patient was asked to do all the functional movements and to stare at a point directly in front. [Figure 4]
  • After the material was fully set, the impression was removed and poured in type IV dental stone using two pour technique [Figure 5]
  • A wax pattern was made on the stone model and then tried in the patient's eye socket [Figure 6]. The size, eyelid coverage, tissue support, and stimulation of eye movements were checked
  • A stock iris button was selected by matching with the size, color, contour of the contralateral eye.[Figure 7]a
  • The iris button was placed on the wax pattern after centering the pupil on both the sides.[Figure 7]b
  • The wax pattern was invested in a denture flask [Figure 8]. The prosthesis was then processed with heat cured tooth-colored acrylic resin
  • The prosthesis was retrieved from the flask and trimmed of the surface irregularities and flashes
  • The prosthesis was polished with pumice slurry and was tried in the patient's eye socket. The esthetics and degree of various movements were checked. Minor corrections were done as required and it was finished and polished before insertion
  • The method of inserting and removing the prosthesis and its care was demonstrated to the patient. The prosthesis should be removed at least once a day for cleaning. The prosthesis should not be allowed to come in contact with alcohol or solvents of any kind as this would lead to crazing of the acrylic resin. It should be washed with mild soap once every 1 or 2 weeks. More frequent cleansing would be indicated if dusty or dirty conditions may be encountered. In such conditions, the soft tissues of the socket are rinsed with an ophthalmic irrigant
  • The patient was recalled after 1 week for check-up. The eye socket was healthy and without any inflammation. The patient was happy and comfortable with the improvement in the appearance with regard to the fullness and the amount of movement possible with the new ocular prosthesis [Figure 9].
Figure 1: Preoperative photograph

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Figure 2: Primary impression made using irreversible hydrocolloid

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Figure 3: Primary impression poured in Type III dental stone using two pour technique

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Figure 4: Final impression made using light body

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Figure 5: Final impression poured in Type IV dental stone using two pour technique

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Figure 6: Wax pattern fabricated over master cast

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Figure 7: (a) Selection of appropriate stock iris (b) centring of the pupil on both the sides

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Figure 8: Mold for packing heat cure acrylic resin

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Figure 9: Final prosthesis

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  Discussion Top


A time-tested method of fabrication of ocular prosthesis is described here. Although the effects of enucleation in early childhood on facial symmetry and orbital volume are still debated, advantages of ocular prosthesis in a school going child extends beyond esthetics. It helps in building confidence in the child, makes them more acceptable to their peer group and help in developing their personality. This technique also permits the finished prosthesis to generate an equal distribution of pressure and intimate adaptation to tissue bed.

A technique for fabrication of a custom-made ocular prosthesis has been described. A prosthesis cannot restore vision, but it definitely reduces the psychological trauma of being without an eye. A properly fabricated custom-made prosthesis enhances the patient's comfort and confidence by increased adaptiveness and natural appearance, and also maintains its orientation when the patient performs various eye movements.

Declaration of patient consent

The authors certify that they have obtained all appropriate patient consent forms. In the form the patient(s) has/have given his/her/their consent for his/her/their images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.

 
  References Top

1.
Nafij BJ, Theerathavaj S, Mohammad KA. A complete procedure of ocular prosthesis: A case report. Int Med J 2013;20:729-30.  Back to cited text no. 1
    
2.
Kaur A, Pavaiya A, Singh SV, Singh RD, Chand P. A simplified approach to fabrication of an ocular prosthesis: A case series. Indian J Dent Res 2010;21:615-7.  Back to cited text no. 2
[PUBMED]  [Full text]  
3.
Marunick MT, Harrison R, Beumer J 3rd. Prosthodontic rehabilitation of midfacial defects. J Prosthet Dent 1985;54:553-60.  Back to cited text no. 3
    


    Figures

  [Figure 1], [Figure 2], [Figure 3], [Figure 4], [Figure 5], [Figure 6], [Figure 7], [Figure 8], [Figure 9]



 

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