Orbital Implants and Eye Prosthesis

Eye Removal SurgeryEnucleation (enucleation, evisceration)Evisceration is often considered as a lost battle in ophthalmology as there is no hope for restoring vision. The technique of eye removal is constantly evolving. A major focus of research and development in the last couple of decades is the newer materials for orbital implant and improvement in prosthesis motility. Porous materials are currently preferred primarily because of vascularization and integration that occur. These implants are less likely to migrate than silicone or PMMA implants and are associated with better prosthesis motility especially when coupled with a peg. However, hydroxyapatite and porous polyethylene are significantly more expensive and are associated with higher rates of exposure than traditional non integrated implants. Wrapping or “capping” these implants appears to reduce the exposure rate to acceptable levels. Implant size is crucial and should be customized. Implant motility is primarily determined by the attachment of extraocular muscles the implant. Placement of wrapped silicone or PMMA implant with extraocular muscle attachment provides excellent results in patients who do not wish to consider a motility peg placement. Porous implants should be used in patients who are keen on further enhanced motility. Sufferers bears the stigma of disfigurement and some gets disturbed psychologically. One simple solution in in most of these cases is to fit a custom-designed ocular prosthesis (or an artificial eye)Custom artificial eyes that looks like a natural eye and can even move (to varied extent in different conditions). They may not retain the eye sight but they can face life with a great confidence (Older in Levine (ed), Manual of Oculoplastic Surgery, Butterworth-Heinemann, Boston, Mass, 1996;Shore in Levine (ed), Manual of Oculoplastic Surgery, Butterworth-Heinemann, Boston, Mass, 1996;Custer and Reistad in Ophthal Plast Reconstr Surg 16:326–329, 2000;Woog et al. in Dortzbach (ed), Ophthalmic Plastic Surgery: Prevention and Management of Complications, Raven Press Ltd, New York, 1994;). The psychological aspects of loss of an eye should always be addressed by the oculoplastic surgeon and the ocularist and patients may even need the help of a clinical psychologist particularly in children and young adults.Organizing meetings with the ocularist prior to eye removal surgery can be helpful in this regard (Slonim MD, Martino MD. Eye was there: a patient’s guide to coping with the loss of an eye (Kindle Locations 1080–1094). Bloomington: AuthorHouse, Bloomington; 2011. Kindle Edition).