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Authors:Dr .Sumit aggarwal,Dr. Divya Kalra ,Dr. Anshu Kalra (MDS).

Introduction

The eye is a vital organ not only in terms of vision but also being an important component of facial expression. Loss of an eye has a crippling effect on the psychology of the patient.1

Treatment of such cases includes implants and acrylic eye prosthesis. Although implant eye prosthesis has superior outcome, due to anatomical and economical factors it may not be advisable in all patients .

So a pre-fabricated scleral shell prosthesis is a good alternative.2

A case of pre-fabricated scleral shell prosthesis is presented here, which has acceptable fit, movements as that of the contra-lateral eye, retention and esthetics.
Why ocular rehabilitation?

Eyes are generally the first features of face to be noticed. Removal of this organ either due to any pathology, trauma or any other condition not only causes unaesthetic look but also there is loss of function and has a psychological effect on the patient. Thus, ocular prosthesis should be provided as soon as possible for the psychological well being of the patient.3

The most often encountered artificial eye is the acrylic prosthetic eye which is used to replace a natural eye which has been either "enucleated" or "eviscerated". These are the medical terms for surgical removal of all or part of a severely damaged, diseased, or tumored eye.. 4



Clinical Report

A male patient aged 16 years reported to the Department of Prosthodonticsdontics with a chief complaint of missing right eye .A careful medical history revealed that the right eye was eviscerated for removal of a tumor at the age of 9 years.On examination of the eye it was noted that the intraocular tissue bed was healthy and with adequate depth in between the upper and lower fornices for retention of the prosthesis. [Figure 1]

The patients eye's vision was lost, but the eye was not completely removed, the usual deterioration in appearance can be very successfully corrected by the use of a thin acrylic scleral shell. Scleral shells involve fitting a thin 1 millimeter or less  shell to fully cover a natural eye that has become disfigured and often is very sensitive and painful.

The highly positive feature of a thin scleral shell prosthetic eye is that it provides for virtually natural motion, since the natural eye is retained under the shell to aid in full movement to the prosthesis.

This type of artificial eye requires absolutely the highest degree of precision fitting if the shell is to be worn and enjoyed full time.A suitable acrylic resin stock eye prosthesis was selected accurately the matching the contra lateral eye Specially fabricated acrylic resin trays were used to make the impression of the orbit [Figure 2 and Figure 3]

The intra-orbital topography was recorded by low viscosity poly-vinyl siloxane impression material by instructing the patient to perform all the movements of the eye until the impression material was set. [Figure 4]

Thus the exact replica of the orbit and peripheries was obtained by pouring the impression in dental stone.[Figure 5(a) &(b)]
The acrylic resin stock eye was trimmed precisely until it was accurately fitting into the socket.




The bulge of the eye was accurately gained as of the contra-lateral eye by the addition of wax onto the tissue surface.Once the correct bulge was obtained it was again relined with soft tissue conditioner and placed into the socket of the patient instructing to do all movements of the eye to record the functional movements of the eye.[Figure 6]







After the functional movements of the eye was recorded by the tissue conditioner, the wax and the tissue conditioner was replaced by heat cure clear acrylic resin which was cured in the long cycle to eliminate as much as the monomer.[Figure 7]






The finished prosthesis was trimmed and polished to attain a highly smooth and glazed surface.[Figure 8]

The following instructions were given  to the patient :

  1. The prosthesis should be washed in dilute soap solution and to be stored in water.
  2. Eye glasses to worn
  3. Recall after every 6 months.

Discussion

The scleral shell prosthesis is an artificial replacement for the sclera of the eye. After the surgeon eviscerates the eye, maxillofacial Prosthodonticsdontist is a person who comes into an act of providing the patient with artificial eye to overcome the agony of losing an eye. 5
A well-made, properly planned and functionally molded scleral shell prosthesis maintains its orientation when patient performs various movements.
The various advantages of this simple technique are 6

  • Minimal or no post insertion complaints as the tissue surface of the prosthesis is functionally molded
  • Particularly useful in a growing child where the socket needs to be readapted regularly i.e. the existing prosthesis can be relined easily.
  • Better tissue tolerance
  • Minimum time required for the fabrication of the prosthesis.

Conclusion
A false eye is not prosthetic in the way a wooden leg is—it cannot replace lost function.
A false eye does remedy to the harm done to vision, but it is other people's vision of the wearer that gets corrected. The appearance of the world is not preserved for the one whose sight has been impaired, but that person's appearance is restored in the eyes of the world.

Biblography

  • Prosthodonticsdontic Rehabilitation Of Patient With Ocular Defect Using A Graph Grid.Indian journal of dental sciences 2010: Vol. 2 ( 6):36-38.
  • Michael O. Hughes. : Ocular Implants and Orbital Reconstruction:Two Follow-Up Cases. Journal of Ophthalmic Prosthetics 2005.
  • Clinical Maxillofacial Prosthetics -  Thomas D. Taylor
  • Varoujan A Chalian: Extraoral prosthetic
  • Maxillofacial Rehabilitation - Prosthodonticsdontic and surgical consideration John Beumer.
  • P J Doshi et al.: Prosthetic management of patients with Ocular defects: JIPS: Jan-March 2005: vol 5(1): 37-38

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