Eye prosthesis / dental courses

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INDIAN DENTAL ACADEMY
Leader in continuing dental education

CONTENTS-
 Introduction
 Embryology of an eye
 Anatomy of an eye
 Evolution and history of artificial eye
 Surgical consideration
 Fabrication procedure
 Patient instruction
 Orbital defect and restoration
 Recent advances
 Conclusion
 References .

JOHN BEUMER DDS,MSwww.indiandentalacademy.com

embryolowww.indiandentalacademy.com

Anatomy

Evolution and history
Egyptian –bronze
And precious stone Romans -silver eye

Unearthed an artificial eye that is believed to be 5,000
years old. It was worn by a female believed to have lived
in ancient Arabia; she was aged between 25 and 30
years. This is the earliest prosthetic eye ever found.

Ambrose pare 1510-1590
Ekblephara
Hypoblephara

Artificial glass eye

Enamel eye
(1820 – 1890)

Terminologies
 Anopthalmos
micropthalmos

Evisceration

Enucleation

Exenteration

Step by step procedure for ocular prosthesis
Examination –
* Ensure proper healing
* Absence of infection
* Movement of tissue bed
* Type of surgery done
* Size and extent of the socket
* Amount of orbital adipose tissue present
* Extent of atrophy of muscles

Impression technique

Direct / External impression technique
(JPD 1970 :24;2page 225-235)

Modified stock eye ocular prosthesis
(Jpd 1985;54:95-98 )

Wax Scleral Blank Technique
J Prosthet Dent 1986;55:482-485

A quasi-integrated custom ocular prosthesis.
(J Prosthet Dent 1974;32:439-442)

Autoclavable custom-made metal impression trays to
improve infection control.
(J Prosthet Dent 1987;58:121-122)

The fitting and fabrication of a custom resin eye
Jpd 1977;38:532-538www.indiandentalacademy.com

The Ocular Impression,
(J Prosthodont 2000;9:210-216)

CAST FABRICATION

 Poured in two section
 Impression is boxed with 3 inch masking tape
 First half of the cast is poured with a mix of dental stone
and slurry
 Pour up to and around the widest part of socket
impression
 At least two key ways are cut

 Separating media
 Second half poured
 Mold can be separated after stone has set

Fabrication of sclera
 Enlarge mold opening
 Pour molten wax – cool
 Wax pattern is recovered
 Anterior surface is contoured into smooth hemi
spheroid
 Posterior surface reflects the tissue topography

 Try wax pattern in eye-should be comfortable.
 Acrylic sclera is recovered and polished.
 Tried in eye and verified.www.indiandentalacademy.com

 With sclera in placed and patient standing in a
relaxed position
 Center of pupil marked in comparison with the
natural eye
 Circle scribed of diameter of natural eye
 Consider the iris in relation to opening of eye lid
Iris location

An instrument to achieve pupil alignment in
eye prosthesis JPD 1969;22:487-489

•
JPD 1984;51 :3
A method for orienting
the ocular portion of an
Orbital prosthesis

A Simple Method of Positioning the Iris Disk on a
Custom-Made Ocular Prosthesis. A Clinical Report
Journal of Prosthodontics 17 (2008) 223–227

Digital imaging in the fabrication of ocular
prostheses JPD;2006;95;327-330

Iris illustrations

 1)Acrylic paints on water proof paper disks
 2)Oil paints on acetate disks
 a)Mono-poly
 b)Oil paint and linseed oil

Veining technique
 Red rayon threads applied with 5% solution of
monomer and polymer
 Follow natural pattern
 Use 00 sable brush with pointed tip

Complications
1) Ptosis
2) lower eye lid droop

Entropion
Ectropion

0ther condition include
• Blepharosulcus
• Symblepharon
• Contracted socket

OCULAR IMPLANT
• Placed in tissue bed to aid in prosthesis fabrication
• Implant moves as muscles move in normal course –
results in more realistic prosthesis

Ocular prosthesis: A physiologic
system. J Prosthet Dent 1973;29:450-459

IMPLANT INSERTION
• Following enucleation tenon’s capsule is preserved
• Implant placed, dissected ocular muscles attached to
it
• Superior and inferior recti are overlapped at center of
implant at 12 o’clock and 6 o’clock positions
• Lateral and medial recti are overlapped and sutured
at 3 o’clock and 9 o’clock positions

• Complete the closure
• Conformer placed to reduce edema and maintain
socket size
• Stock prosthesis placed
• Custom fabricated prosthesis given at later date

Types of Ocular implant
Buried Buried, semi-integrated
Semi-buried, integrated

Instruction to the patient

 Adjusting to the prosthesis
 Artificial eye does not track with natural eye
* Movement of the prosthesis is limited
* Learn to turn your head rather than your eyes
* Try to avoid looking upward
* Try to use spectacles
 prosthesis hygiene-
*Wash hands before handling the prosthesis

*Clean prosthesis in liquid detergent and don’t use any
chemical solution for cleaning.
*Wash thoroughly with cold water and if possible keep
in saline water before insertion.
 Removal and insertion-

Period of wear
Recall – 1 year systemwww.indiandentalacademy.com

Orbital
prosthesis

• Facial moulage
Avoid displacement of tissue,
Patient must be seated in upright position,
Use irreversible hydrocolloid,
Record impression of the defect,
 Use pins to support impression,
 Fabricate primary cast in ,
 Fabrication of tray,
 Master cast.

Select a stock ocular prosthesis
 Use clay or wax for sculpting
Drill hole in posterior orbital wall

 Retention
 Skin adhesives
 Engagement of undercuts
 Attachment to eyeglass frame
 Extra oral craniofacial implant

Cad cam orbital prosthesis
Int jour of prostho 2009;22:293-295

Blinking eye prosthesis
Ref college of engineering
university of wisconsin

conclusion

Refrences
1. Maxillo facial prosthetics by Chalian, Drane and
Standish
2. Maxillofacial rehabilitation by Beumer, Curtis and
Firtell
3. Human anatomy by Chaurasia
4. Human embroyology by Inderbeer singh
5. JPD 1970 :24;225-235
6. JPD1974;32:439-442
7. JPD 1985;54:95-98
8. JPD 1986;55:482-485

• JPD1987;58:121-122
• JPD1977;38:532-538
• J Prosthodontics 2000;9:210-216
• JPD 1969;22:487-489
• JPD 1973:29:450-459
• JPD 1984;51 :3
• J Prosthodontics 17 (2008) 223–227
• JPD;2006;95;327-330
• JPD1973;29:450-459
• Int jour of prostho 2009;22:293-295

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