Eye prosthesis/ cosmetic dentistry training

Eye prosthesisEye prosthesis
INDIAN DENTAL ACADEMY
Leader in continuing dental education
www.indiandentalacademy.com
www.indiandentalacademy.comwww.indiandentalacademy.com

IntroductionIntroduction

DevelopmentDevelopment
 Lens placodeLens placode
 Directed laterally face forwardsDirected laterally face forwards
with narrowing of fronto nasalwith narrowing of fronto nasal
processprocess
 Eyelids from ectodermal foldsEyelids from ectodermal folds
 Conjunctiva - ectodermalConjunctiva - ectodermal

AnatomyAnatomy
 OrbitOrbit
 Pyramidal bony cavitiesPyramidal bony cavities
 Provide socket for rotatory movements ofProvide socket for rotatory movements of
the eye ballthe eye ball
 4 sided pyramid –4 sided pyramid –
a) apexa) apex
b) baseb) base
c) 4 walls –c) 4 walls – roof ,floor, lateral & medialroof ,floor, lateral & medial

 Long axis of orbit passes backward andLong axis of orbit passes backward and
mediallymedially
 Medial walls of two orbits are parallel andMedial walls of two orbits are parallel and
lateral walls are set at right angleslateral walls are set at right angles
 Roof:Roof:
 Orbital plate of frontal boneOrbital plate of frontal bone
 Lesser wing of sphenoidLesser wing of sphenoid

 Lateral wall:Lateral wall:
 Thickest, strongestThickest, strongest
 Greater wing of sphenoidGreater wing of sphenoid
 Frontal process of zygomatic boneFrontal process of zygomatic bone
 Houses superior orbital fissureHouses superior orbital fissure
 Floor:Floor:
 Orbital surface of maxillaOrbital surface of maxilla
 Orbital surface of zygomatic boneOrbital surface of zygomatic bone
 Orbital process of palatine boneOrbital process of palatine bone
 Houses inferior orbital fissureHouses inferior orbital fissure

 Medial:Medial:
 Very thinVery thin
 Frontal process of maxillaFrontal process of maxilla
 Lacrimal boneLacrimal bone
 Orbital plate of ethmoidOrbital plate of ethmoid
 Body of sphenoid boneBody of sphenoid bone

EyelidsEyelids
 Also called palpebraeAlso called palpebrae
 Movable curtains, protect eyesMovable curtains, protect eyes
 Palpebral fissurePalpebral fissure
 Medial and lateral canthiMedial and lateral canthi

Contents of orbitContents of orbit
 EyeballEyeball
 FasciaFascia
 Muscles – extraocularMuscles – extraocular
 VesselsVessels
 NervesNerves
 Lacrimal glandLacrimal gland
 Orbital fatOrbital fat

Extraocular musclesExtraocular muscles
 Voluntary :Voluntary :
 four rectifour recti
 superiorsuperior
 InferiorInferior
 MedialMedial
 laterallateral
 Two obliquiTwo obliqui
 SuperiorSuperior
 InferiorInferior
 Levator palpebraeLevator palpebrae
superiorissuperioris

 InvoluntaryInvoluntary
Superior tarsalSuperior tarsal
Inferior tarsalInferior tarsal
orbitalisorbitalis

MuscleMuscle OriginOrigin InsertionInsertion
Four rectiFour recti CommonCommon
annular ringannular ring
ScleraSclera
SuperiorSuperior
obliqueoblique
Body ofBody of
sphenoidsphenoid
ScleraSclera
InferiorInferior
obliqueoblique
OrbitalOrbital
surface ofsurface of
maxillamaxilla
ScleraSclera
LevatorLevator
palpebraepalpebrae
superiorissuperioris
Greater wingGreater wing
of sphenoidof sphenoid
SuperiorSuperior
tarsustarsus

 Nerve supplyNerve supply
 Superior - trochlear (4 th cranial)Superior - trochlear (4 th cranial)
 Lateral rectus - abducent (6 thLateral rectus - abducent (6 th
cranial)cranial)
 Rest ocular muscles - oculomotor (3Rest ocular muscles - oculomotor (3
rd)rd)

 Action of extra ocular musclesAction of extra ocular muscles

Eye ballEye ball
 Organ of sightOrgan of sight
 3 coats:3 coats:
 Outer fibrous coatOuter fibrous coat
 Middle vascular coatMiddle vascular coat
 Inner nervous coatInner nervous coat

ScleraSclera
 Opaque, posterior 5/6Opaque, posterior 5/6
 Firm, maintains shapeFirm, maintains shape
 Outer surface – white, smooth,Outer surface – white, smooth,
covered with tenson’s capsule,covered with tenson’s capsule,
anteriorly covered by conjunctivaanteriorly covered by conjunctiva
 Inner surface – brownInner surface – brown
 Continuous anteriorly with corneaContinuous anteriorly with cornea

 Provides insertion to muscles:Provides insertion to muscles:
 Recti in front of equatorRecti in front of equator
 Oblique behind the equatorOblique behind the equator
sclera is almost avascularsclera is almost avascular

 CorneaCornea
 Transparent, anterior 1/6, avascularTransparent, anterior 1/6, avascular
 ChoroidChoroid
 Thin pigmented layer, separatesThin pigmented layer, separates
sclera from retina in posterior partsclera from retina in posterior part

 IrisIris
 circular curtain with an opening incircular curtain with an opening in
center called the pupilcenter called the pupil
 colour determined by number ofcolour determined by number of
pigment cells in connective tissue of irispigment cells in connective tissue of iris
 RetinaRetina
 thin delicate inner layer continuous withthin delicate inner layer continuous with
optic nerveoptic nerve

Evolution of ocular prothesisEvolution of ocular prothesis
 Egypt (before 3000 B.C.)-bronze and preciousEgypt (before 3000 B.C.)-bronze and precious
stone eyesstone eyes
 Romans – silver eyesRomans – silver eyes
 Ambrose Pare (1510-1590) : first to describeAmbrose Pare (1510-1590) : first to describe
use of artificial eye to fit an eye socket, useduse of artificial eye to fit an eye socket, used
both glass and porcelain eyesboth glass and porcelain eyes

 1820-1890’s – enamel prosthesis very1820-1890’s – enamel prosthesis very
attractive but expensive and not very durableattractive but expensive and not very durable
 By 1835 artificial eyes were being producedBy 1835 artificial eyes were being produced
on a large scale in Germanyon a large scale in Germany
 1943 – united states army and navy developed1943 – united states army and navy developed
acrylic eyeacrylic eye

 Advantages of plastic eye:Advantages of plastic eye:
 Freedom from fragility and surface etchingFreedom from fragility and surface etching
 Easy adjustments of size and formEasy adjustments of size and form
 Esthetics requirements could be addedEsthetics requirements could be added
 Actual 3 dimensional effectActual 3 dimensional effect
 Pre fabricated iris buttons can be stockedPre fabricated iris buttons can be stocked
 Less time consuming and each to teachLess time consuming and each to teach

Surgical consideration in prosthetic treatmentSurgical consideration in prosthetic treatment
of ocular and orbital defectsof ocular and orbital defects
 EviscerationEvisceration
 involves removal ofinvolves removal of
the contents of the globethe contents of the globe
leaving in place theleaving in place the
sclera and sometimessclera and sometimes
corneacornea
 spherical implant isspherical implant is
generally placed – sizegenerally placed – size
is importantis important
 best prosthetic option isbest prosthetic option is
cover shellcover shell www.indiandentalacademy.comwww.indiandentalacademy.com

 EnucleationEnucleation
 Removal of entire globe afterRemoval of entire globe after
the extra ocular muscles andthe extra ocular muscles and
optic nerve have been transectedoptic nerve have been transected
 Implants are placed in tenon’s capsule to fillImplants are placed in tenon’s capsule to fill
orbital defect and support the muscles andorbital defect and support the muscles and
eyelidseyelids

 ExenterationExenteration
Removal of the entire contents of orbit includingRemoval of the entire contents of orbit including
the extra ocular musclesthe extra ocular muscles
Periosteum may or may not be maintainedPeriosteum may or may not be maintained
The eyelids may or may not be involvedThe eyelids may or may not be involved
1)1) leave the eye lids intactleave the eye lids intact
2)2) Preserve but split the lidsPreserve but split the lids
3)3) Remove lids totallyRemove lids totally

 Presurgical conferences between the involvedPresurgical conferences between the involved
specialists will help to resolve manyspecialists will help to resolve many
rehabilitative problems leading to more idealrehabilitative problems leading to more ideal
restorative treatmentrestorative treatment

Ocular prosthesisOcular prosthesis
Fabrication:Fabrication:
Examination –Examination –
• ensure proper healingensure proper healing
• absence if infectionabsence if infection
• location of implantlocation of implant
• movement of tissue bedmovement of tissue bed
• Type of surgery doneType of surgery done
• size and extent of the socketsize and extent of the socket
• Amount of orbital adipose tissue presentAmount of orbital adipose tissue present
• Extent of atrophy of musclesExtent of atrophy of muscles

ImpressionImpression
A.A. Impression made from irreversibleImpression made from irreversible
hydrcolloid:hydrcolloid:
 Impression tray: hard baseplate waxImpression tray: hard baseplate wax
 Wax handleWax handle
 Tissue side is scored with hot spatulaTissue side is scored with hot spatula
 Seated erect, asked to stare at a distant spot, holdSeated erect, asked to stare at a distant spot, hold
his gaze in a straight forward position with eyeshis gaze in a straight forward position with eyes
open while impression is madeopen while impression is made

 Material mixed: smooth, runny mix which setsMaterial mixed: smooth, runny mix which sets
quicklyquickly
 Placed in large syringe, injected in socketPlaced in large syringe, injected in socket
completely filling the socket without trappingcompletely filling the socket without trapping
tiny air bubblestiny air bubbles
 After set remove in one piece – care taken notAfter set remove in one piece – care taken not
to tearto tear

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

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

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

 Try wax pattern in eye-should be comfortableTry wax pattern in eye-should be comfortable
 Invest using denture flask or crown and bridgeInvest using denture flask or crown and bridge
flaskflask
 After investing wax pattern is recoveredAfter investing wax pattern is recovered
 Packed with scleral white acrylic resinPacked with scleral white acrylic resin
( or 1.5 gm zinc oxide with 100 gm of clear( or 1.5 gm zinc oxide with 100 gm of clear
acrylic)acrylic)

 Processed at 150 f for 9 hours and at 212 FProcessed at 150 f for 9 hours and at 212 F
for 2 hoursfor 2 hours
 Acrylic sclera is recovered and polishedAcrylic sclera is recovered and polished
 Tried in eye and verifiedTried in eye and verified

Iris locationIris location
 With sclera in placed and patient standing in aWith sclera in placed and patient standing in a
relaxed positionrelaxed position
 Center of pupil marked in comparison with theCenter of pupil marked in comparison with the
natural eyenatural eye
 Circle scribed of diameter of natural eyeCircle scribed of diameter of natural eye
 Consider the iris in relation to opening of eye lidConsider the iris in relation to opening of eye lid
 A piece of 28 guage casting wax is positioned overA piece of 28 guage casting wax is positioned over
the iris circle-smoothened and merged leaving athe iris circle-smoothened and merged leaving a
depression when reinvesteddepression when reinvested

 ReinvestedReinvested
 The depression formed by casting wax isThe depression formed by casting wax is
deepened by 2mm- gives corneal prominencedeepened by 2mm- gives corneal prominence
 Sclera is cut down for incorporation of iris- 3Sclera is cut down for incorporation of iris- 3
to 5 mmto 5 mm
 Inserted again in socket for verificationInserted again in socket for verification

 Anterior portion of sclera reduced by 1-1.5Anterior portion of sclera reduced by 1-1.5
mmmm
 Sclera is tinted:Sclera is tinted:
Children – blueChildren – blue
light skinned – lighter blue or greenlight skinned – lighter blue or green
Darker skinned – brown to orangeDarker skinned – brown to orange
 Blood vessels – painted or rayon/cotton fiberBlood vessels – painted or rayon/cotton fiber

 Replaced in flaskReplaced in flask
 Packed with clear acrylicPacked with clear acrylic
 Cured, finished and polishedCured, finished and polished

Iris illustrationsIris illustrations
 Acrylic paints on water proof paper disksAcrylic paints on water proof paper disks
 Oil paints on acetate disksOil paints on acetate disks
 Mono-polyMono-poly
 Oil paint and linseed oilOil paint and linseed oil
 Iris button is inserted in cavity prepared byIris button is inserted in cavity prepared by
removing wax in iris arearemoving wax in iris area

 Scleral wax pattern with iris illustrationsScleral wax pattern with iris illustrations
waxed in position are invested, processed,waxed in position are invested, processed,
polishedpolished

Modification of stock eyeModification of stock eye
 Select a stock eye of correct size, colour andSelect a stock eye of correct size, colour and
shapeshape
 Reduce periphery and posterior surfaces by 2-Reduce periphery and posterior surfaces by 2-
3 mm3 mm
 Retentive groove in posterior surfaceRetentive groove in posterior surface
 Small straight stick is secured with sticky waxSmall straight stick is secured with sticky wax
over pupil – acts handle and guide for aligningover pupil – acts handle and guide for aligning

 Irreversible hydrocolloid placed at back ofIrreversible hydrocolloid placed at back of
prosthesis and impression recordedprosthesis and impression recorded
 Prosthesis and impression are investedProsthesis and impression are invested
 Two small projection of auto polymerizingTwo small projection of auto polymerizing
resin attached to canthus area- hold prosthesisresin attached to canthus area- hold prosthesis
in correction relationin correction relation
 Pack, process and polishPack, process and polish

B.B. Using steel ball bearing:Using steel ball bearing:
 Given by Dr. Victor DeitzGiven by Dr. Victor Deitz
 Horizontal measurement of eye socket determinesHorizontal measurement of eye socket determines
the size of ball bearingthe size of ball bearing
 Hard base plate wax is softened and compressedHard base plate wax is softened and compressed
over the ball bearingover the ball bearing
 Wax cup is trimmed to triangular shape of posteriorWax cup is trimmed to triangular shape of posterior
wall of socket – tried in socketwall of socket – tried in socket

 Center of iris is marked on wax with a suitableCenter of iris is marked on wax with a suitable
instrumentinstrument
 Iris button with handle placed on hard wax cupIris button with handle placed on hard wax cup
 Whole assembly tried in eye and necessaryWhole assembly tried in eye and necessary
corrections madecorrections made
 A special yellow high heat wax is used toA special yellow high heat wax is used to
build up a smooth spherical prosthesisbuild up a smooth spherical prosthesis

FlaskingFlasking
 Invested in HUE-LON flask with anteriorInvested in HUE-LON flask with anterior
surface downsurface down
 After separation and removal of wax, irisAfter separation and removal of wax, iris
button is carefully lifted and again replacedbutton is carefully lifted and again replaced
after applying separating media in exactafter applying separating media in exact
positionposition
Prepare scleral modifying and veining coloursPrepare scleral modifying and veining colours

PackingPacking
 Select proper scleral shadeSelect proper scleral shade
 Mix it with monomer in ratio of 1:3Mix it with monomer in ratio of 1:3
 Pack, place in dry heat oven at 100 c for 3Pack, place in dry heat oven at 100 c for 3
hourshours
 Recover, polishRecover, polish

Veining techniqueVeining technique
 Red rayon threads applied with 5% solution ofRed rayon threads applied with 5% solution of
monomer and polymermonomer and polymer
 Follow natural patternFollow natural pattern
 Use 00 sable brush with pointed tipUse 00 sable brush with pointed tip
 Add dry pigments mixed in 5% momomer andAdd dry pigments mixed in 5% momomer and
polymer solutionpolymer solution
 Next apply 3 coats of 5% solution of clearNext apply 3 coats of 5% solution of clear
monomer and polymermonomer and polymer

 Each coat is dried for 4-5 minEach coat is dried for 4-5 min
 Processed in oven at 72 C for 1 hourProcessed in oven at 72 C for 1 hour

ConjunctivaConjunctiva
 Wood applicator attached at concave surfaceWood applicator attached at concave surface
with sticky waxwith sticky wax
 Dip in molten base plate waxDip in molten base plate wax
 Flask, boil out wax and pack with clear acrylicFlask, boil out wax and pack with clear acrylic
 Cure at 100 C for 3 hoursCure at 100 C for 3 hours
 Finish and polish, attaining high lusterFinish and polish, attaining high luster

ComplicationsComplications
 Ptosis :Ptosis :
• Pseudo ptosisPseudo ptosis
• True ptosis – Allen (1976)True ptosis – Allen (1976)
 Lower lid droopLower lid droop
 Entropion and ectropioEntropion and ectropio
• Surgically – reen and beyer (1976)Surgically – reen and beyer (1976)
• Prosthetically – Bulgarelli (1976)Prosthetically – Bulgarelli (1976)
 BlepharosulcusBlepharosulcus

 Cicatricial bands or adhesionsCicatricial bands or adhesions
 Contracted socketContracted socket

Orbital DefectOrbital Defect
 Facial moulageFacial moulage
 Avoid displacement of tissueAvoid displacement of tissue
 Patient must be seated in upright positionPatient must be seated in upright position
 Use irreversible hydrocolloidUse irreversible hydrocolloid
 Master castMaster cast
 Fabricate trayFabricate tray

 Record impression of the defectRecord impression of the defect
 Use pins to support impressionUse pins to support impression
 Fabricate cast in dental stoneFabricate cast in dental stone
 Drill hole in posterior orbital wallDrill hole in posterior orbital wall
 Select a stock ocular prosthesisSelect a stock ocular prosthesis
 Use clay or wax for sculptingUse clay or wax for sculpting
 Try in patientTry in patient

 Mark the mid lineMark the mid line
 Mediolateral, anteroposterior and inferiorMediolateral, anteroposterior and inferior
superior positioning should mimic exactly thesuperior positioning should mimic exactly the
position of natural eyeposition of natural eye
 Next sculpting of peri-orbital tissue isNext sculpting of peri-orbital tissue is
effectedeffected
 Lines of juncture should be featheredLines of juncture should be feathered
 Ended beneath eyeglasses or the shadow castEnded beneath eyeglasses or the shadow cast
by themby them

Material selection and processingMaterial selection and processing
 Fabricate the molds usual except thatFabricate the molds usual except that
ocular prosthesis must be removedocular prosthesis must be removed
 Acrylic resin –Acrylic resin – pour a layer of stone over thepour a layer of stone over the
completed external surfacecompleted external surface
 Remove ocular prosthesis carefully from theRemove ocular prosthesis carefully from the
hole previously drilled in the posterior wallhole previously drilled in the posterior wall
 Dental stone is then vibrated filling the areaDental stone is then vibrated filling the area
occupied by ocular prosthesisoccupied by ocular prosthesis

 Flexible materialFlexible material – ocular prosthesis should– ocular prosthesis should
be duplicated, inserted in appropriate positionbe duplicated, inserted in appropriate position
in the moldin the mold
 According to Beumer: if prosthesis is limitedAccording to Beumer: if prosthesis is limited
to orbital area methyl methacrylate is theto orbital area methyl methacrylate is the
material of choicematerial of choice
 Flexible material should be used when defectFlexible material should be used when defect
extends beyond the orbital area and encountersextends beyond the orbital area and encounters
movable tissuemovable tissue

 Process in favoured materialProcess in favoured material
 Tint either intrinsically or extrinsically or bothTint either intrinsically or extrinsically or both
 Attach prosthetic eye lashesAttach prosthetic eye lashes
 Secure resin eye with auto polymerizing resinSecure resin eye with auto polymerizing resin

RetentionRetention
 Skin adhesivesSkin adhesives
 Engagement of undercutsEngagement of undercuts
 Attachment to eyeglass frameAttachment to eyeglass frame

 According to Chalian and Drane:According to Chalian and Drane:
 Facial moulage is made using reversibleFacial moulage is made using reversible
hyrdo colloidhyrdo colloid
 Prepare the cast in usual mannerPrepare the cast in usual manner
 Select stock acrylic eyeSelect stock acrylic eye
 Carve clay pattern, place stock eye and try inCarve clay pattern, place stock eye and try in
place several timesplace several times

Constructing metallic moldConstructing metallic mold
 Impression and cast of external moldImpression and cast of external mold
 Seat properly in moldSeat properly in mold
 Outline the cast with indelible pencil 1cmOutline the cast with indelible pencil 1cm
away from clay patternaway from clay pattern
 Box entire area beyond the pencil outlineBox entire area beyond the pencil outline
 Pour impression materialPour impression material
 After material sets, remove the impression,After material sets, remove the impression,
box it and pour in gray investment materialbox it and pour in gray investment material

 Impression and cast of tissue side moldImpression and cast of tissue side mold
 Cut out clay in back of eye periphery, leavingCut out clay in back of eye periphery, leaving
no undercutsno undercuts
 Make key ways in clayMake key ways in clay
 Floor of the orbital defect is also keyedFloor of the orbital defect is also keyed
 Minimal amount of quick setting plaster isMinimal amount of quick setting plaster is
placed within the eye periphery withplaced within the eye periphery with
additional amount in eye orbitadditional amount in eye orbit

 Clay pattern is quickly and accurately placedClay pattern is quickly and accurately placed
on master caston master cast
 After setting, clay is carefully removedAfter setting, clay is carefully removed
 Prepare an undercut necessary for retention ofPrepare an undercut necessary for retention of
eye in final prosthesiseye in final prosthesis
 Once again box, record alginate impression toOnce again box, record alginate impression to
get negative investment modelget negative investment model

 The negative model is soaked in water andThe negative model is soaked in water and
hydro colloid impression again recordedhydro colloid impression again recorded
 Impression is again boxed and poured to getImpression is again boxed and poured to get
positive modelpositive model
 Both the models- one of external mold andBoth the models- one of external mold and
another of tissue side- are waxed with 3mmanother of tissue side- are waxed with 3mm
base plate waxbase plate wax

 Add spruesAdd sprues
 Invest the molds and let it setInvest the molds and let it set
 Eliminate waxEliminate wax
 Dry heat investment at 70 C for 10 hoursDry heat investment at 70 C for 10 hours
 Cast the investment with molten metalCast the investment with molten metal
 The metal molds should fit togetherThe metal molds should fit together

Painting and processing of vinyl resinPainting and processing of vinyl resin
 Choose the colour of vinyl resinChoose the colour of vinyl resin
 Mix it on glass baseMix it on glass base
 Heat the mold for 3-5 minutesHeat the mold for 3-5 minutes
 Painting on external moldPainting on external mold
 Apply clear vinyl resinApply clear vinyl resin
 Next apply tissue matched vinyl resinNext apply tissue matched vinyl resin
 Each layer is processed in oven for 1 minEach layer is processed in oven for 1 min
 Gain the required thickness, margins are kept freeGain the required thickness, margins are kept free

 Painting on tissue side moldPainting on tissue side mold
 Same procedure as beforeSame procedure as before
 Colour matching not very critical except at theColour matching not very critical except at the
marginsmargins
 Final processingFinal processing
 Place in oven for final vulcanizatiionPlace in oven for final vulcanizatiion
 After heating, place in ice waterAfter heating, place in ice water

 Two halves are separated and trimmedTwo halves are separated and trimmed
 Oil soluble dye retuochingOil soluble dye retuoching
 Required tinting for shade discrepancies doneRequired tinting for shade discrepancies done
with xylene soluble oil dyeswith xylene soluble oil dyes
 Insertion of eye lashesInsertion of eye lashes
 Apply hair with y end needle on upper andApply hair with y end needle on upper and
lower eyelidslower eyelids

 Insert the acrylic eye into the vinyl portion ofInsert the acrylic eye into the vinyl portion of
the prosthesis from the back sidethe prosthesis from the back side
 The prosthesis is ready for placement in orbitalThe prosthesis is ready for placement in orbital
defectdefect
 Use a thin layer of surgical appliance cementUse a thin layer of surgical appliance cement
on tissue surfaceon tissue surface
 Press the margins firmly into placePress the margins firmly into place

Patient instructionsPatient instructions
 Adjusting to the prosthesisAdjusting to the prosthesis
 Artificial eye does not track with natural eye-Artificial eye does not track with natural eye-
learn to turn his head when changing his linelearn to turn his head when changing his line
of visionof vision
 Period of wear: a rest period of 8 hours is notPeriod of wear: a rest period of 8 hours is not
necessary as it is with a denturenecessary as it is with a denture
 Wear eye glassesWear eye glasses

 Removal and insertionRemoval and insertion
 Clean the prosthesisClean the prosthesis
 Application of surgical cementApplication of surgical cement
 Recall – 1 year systemRecall – 1 year system

Ocular implantOcular implant
 Placed in tissue bed to aid in prosthesisPlaced in tissue bed to aid in prosthesis
fabricationfabrication
 Implant moves as muscles move in normalImplant moves as muscles move in normal
course – results in more realistic prosthesiscourse – results in more realistic prosthesis
 Stallard (1973) – beneficial in growingStallard (1973) – beneficial in growing
childrenchildren

Implant insertionImplant insertion
 Following enucleation tenon’s capsule isFollowing enucleation tenon’s capsule is
preservedpreserved
 Implant placed, dissected ocular musclesImplant placed, dissected ocular muscles
attached to itattached to it
 Superior and inferior recti are overlapped atSuperior and inferior recti are overlapped at
center of implant at 12 o’clock and 6 o’clockcenter of implant at 12 o’clock and 6 o’clock
positionspositions
 Lateral and medial recti are overlapped andLateral and medial recti are overlapped and
sutured at 3 o’clock and 9 o’clock positionssutured at 3 o’clock and 9 o’clock positions

 Complete the closureComplete the closure
 Conformer placed to reduce edema andConformer placed to reduce edema and
maintain socket sizemaintain socket size
 Stock prosthesis placedStock prosthesis placed
 Custom fabricated prosthesis given at laterCustom fabricated prosthesis given at later
datedate

Types of Ocular implantTypes of Ocular implant
1.1. BuriedBuried

2. Buried, semi-integrated2. Buried, semi-integrated
3. Semi-buried, integrated3. Semi-buried, integrated

 The first ocular implantThe first ocular implant
made of hydroxyapatitemade of hydroxyapatite
was implanted inwas implanted in
1985, after several years of1985, after several years of
preliminary research.preliminary research.
 The eye muscles can beThe eye muscles can be
attached directly to this implant,attached directly to this implant,
allowing it to move withinallowing it to move within
the orbit-just like the natural eye.the orbit-just like the natural eye.

 The result is a more natural-looking artificial eye thatThe result is a more natural-looking artificial eye that
can be difficult to distinguish from the natural eye.can be difficult to distinguish from the natural eye.
 Some of this movement is automatically transferredSome of this movement is automatically transferred
to the artificial eye, which fits over the implant. Ifto the artificial eye, which fits over the implant. If
greater movement is desired, then a titanium peg isgreater movement is desired, then a titanium peg is
used to connect the artificial eye to the implant.used to connect the artificial eye to the implant.

ConclusionConclusion

ReferencesReferences
1.1. Maxillo facial prosthetics by Chalian, DraneMaxillo facial prosthetics by Chalian, Drane
and Standishand Standish
2.2. Maxillofacial rehabilitation by Beumer,Maxillofacial rehabilitation by Beumer,
Curtis and FirtellCurtis and Firtell
3.3. Human anatomy by ChaurasiaHuman anatomy by Chaurasia
4.4. Human embroyology by Inderbeer singhHuman embroyology by Inderbeer singh

 Surgical considerations in prosthetic treatmentSurgical considerations in prosthetic treatment
of ocular and orbital defects; JPD mar 1983of ocular and orbital defects; JPD mar 1983
 Post insertion care of ocular prosthesis; jpd febPost insertion care of ocular prosthesis; jpd feb
19831983
 JPD 2006 APRJPD 2006 APR

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