Custom Prosthetic Eyes - WAEPS · ocular prosthesis. A HELAING ART PATIENT RESULTS CARE & HANDLING...

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Prosthetic EyesTodd Cranmore BCO/BADO

Licensed Ocularist

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a personalized approach to prosthetic eyes

Realities of Eye Loss‣Anxiety‣Depression‣ Fear of Blindness‣ Loss of Depth

Perception‣ Loss of 15-20%

Peripheral Vision‣ Life goes on...

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Eye Loss Conditions leading to a scleral shell

‣Phthsical Eye‣Accident or Injury‣Retinal Detachment‣Glaucoma‣Corneal Dystrophy‣ Infection‣Evisceration

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Evisceration‣Removal of the contents of

the globe, leaving the sclera and extraocular muscles intact‣ Indications:‣ Endophthalmitis

‣ Improve cosmesis in a blind eye

‣An ocular implant is typically placed during this procedure‣A scleral shell can be fit 6-8

weeks post-op

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Eye Loss Conditions leading to an artificial eye

‣Trauma‣Blind, Painful Eye‣Ruptured Globe‣Tumors / Ocular

Melanoma‣Diabetic Retinopathy‣Endophthalmitis‣ Infection‣Enucleation

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Enucleation‣ Removal of the eye from the

orbit, preserving all other orbital structures‣ Indications:‣ Endophthalmitis‣ Blind Painful Eye‣ Malignant Intraocular Tumors‣ Ocular Trauma‣ Degenerative Phthisis‣ Congenital Anophthalmia‣ Severe Microphthalmia‣ An ocular implant is typically placed during the procedure‣ An artificial eye can be fit

6-8 weeks post-op

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Ocular Implants‣ Solid Sphere‣ Silicone‣ Lucite‣Porous Sphere‣ Hydroxyapatite (H-A, Coral, Bio-Eye™)‣ Porous Polyethylene (Medpore™, Porex™)‣ Aluminum Oxide (Alumina™)‣Dermis Fat Graft

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‣ First visit 1-2 weeks post-op‣ Meet with patient, explain process, ease anxiety‣ Examine socket, fit custom conformer

‣Every 2-3 weeks return for conformer check‣ Monitor healing‣ Change conformer if edema has reduced

‣After 6-8 weeks post-op‣ Begin prosthesis when edema reduced‣ Takes 3-4 appointments to complete prosthesis

Ideal ScheduleEY

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Eye Loss in Children‣ Trauma‣ Retinoblastoma‣ Persistent Hyperplastic

Primary Vitreous (PHPV)‣ Retinopathy of Prematurity

(ROP)‣ Coloboma‣ Coat’s Disease‣ Microphthalmia‣ Anophthalmia

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‣ First visit 1-2 weeks post-op‣ Meet with patient, explain process, ease anxiety‣ Examine socket, fit custom conformer

‣Every 2-3 weeks return for conformer check‣ Monitor healing‣ Change conformer if edema has reduced

‣After 6-8 weeks post-op‣ Begin prosthesis when edema reduced‣ Takes 3-4 appointments to complete prosthesis

Ideal Schedule

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Iris Matching‣ Iris is painted with

powder pigments to match the fellow eye‣Patient is used as

model for accurate matching‣Pattern and color are

accurately painted layer by layer

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Processing Iris Button‣ Iris is capped with

clear acrylic, then cut back on a radial lathe‣ Iris is capped again

with white acrylic‣ Iris is cut back to

reveal a even, realistic blend

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Socket Impression‣ Silicone is injected

through conformer into socket‣ Impression sets in

about 1.5 minutes‣ Important for the

comfort and movement of the ocular prosthesis

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Processing the Blank‣ Impression is set in

cast with castone‣Acrylic dough is

pressed into cast‣Acrylic is processed

with pressure and heat in polymerization unit‣Blank in rough form‣Blank is cleaned up,

shaped and polished

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Fitting the Blank‣Adjustments are made

to equalize lid opening and anterior shape‣ Iris position is marked‣Waxed fitting iris

ensures proper placement and plane

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Attaching the Iris‣ Flat plane with

position marks‣ Iris attached to blank

with acrylic dough‣Blank with attached

iris ready for veining

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Veining and Scleral Tint‣The silk thread is

frayed & set into a layer of acrylic on the prosthesis‣ Sclera is reproduced

using transparencies of acrylic pigment‣Veining is carefully

compared to fellow eye for accuracy

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Final Capping‣Veined prosthesis air

dries, then is capped with clear acrylic‣ Surface is shaped with

grinding tools‣Polished with pumice‣ Finely polished with

polishing compound‣Completed prosthesis

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Final Fitting‣Prosthesis is fit and

adjustments are made to equalize eyelid opening and anterior shape‣Overall cosmetic

appearance, lid function and movement are evaluated

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‣ Fit over phthsical eye‣Up to full-sized globe‣Alternative to colored

contact‣ Sometimes replaces

need for enucleation‣Patient can wear full-

time‣Excellent movement

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Follow-up Schedule‣Return after 2 months‣ Any adjustments are made

for comfort, fit and/or appearance

‣Return every 6 months‣ Polish and resurface

prosthesis‣ Check fit and conjunctival

tissue

‣Replace prosthesis every 5 years

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‣ Fit over phthsical eye‣Up to full-sized globe‣Alternative to colored

contact‣ Sometimes replaces

need for enucleation‣Patient can wear full-

time‣Excellent movement

Scleral Shells

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Scleral Shells

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‣Ocular Prosthetics can easily be removed and replaced.‣ They are held in place by

the lower and upper eyelids and interior fit.‣ Most patients wear their

prosthesis full time, removing only occasionally to clean.‣Wearing full time is ideal.

Prosthetic Handling


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‣Ocular Prosthetics can easily be removed and replaced.‣ They are held in place by

the lower and upper eyelids and interior fit.‣ Most patients wear their

prosthesis full time, removing only occasionally to clean.‣Wearing full time is ideal.

Prosthetic Handling

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Prosthetic Handling‣Always use clean hands‣Check your surroundings

to make sure the prosthesis won't be damaged or lost if it is accidentally dropped‣Do not clean the

prosthesis with any solvents, tooth paste, hand sanitizer, or alcohol, as these chemicals may damage the prosthesis and socket

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Removing a Prosthesis

1) Pull down the lower eyelid with index finger, look up and slide finger towards the ear.

2) Allow the prosthesis to slide out over the lower lid. Gently remove prosthesis.

1) Open eyelids, apply suction cup to prosthesis and squeeze handle. When attached, relax squeeze, holding handle lightly.

2) Pull down lower with finger. Tilt the prosthesis up and out, over the lower lid. Squeeze suction cup handle to release.

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WITH SUCTION CUP:

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Cleaning a Prosthesis1) Wash hands with soap

and warm water2) Use warm water to

rinse and softly scrub the prosthesis with your fingers

3) Only use soap when necessary - a mild soap like baby shampoo and rinse thoroughly

4) Dry with a soft tissue, polishing very lightly in a circular motion

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Inserting a Prosthesis

1) Lift upper lid with index finger to create an opening. Gently slide top edge of prosthesis under upper lid.

2) Release upper lid once prosthesis is in. Pull down lower lid and blink until prosthesis sets into position.

1) Attach suction cup to prosthesis. Lift upper lid and slide top edge of prosthesis under upper lid.

2) Release upper lid and pull down lower lid to seat prosthesis. Release suction cup. Blink eyelids.

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WITH SUCTION CUP:

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Things to Look For‣Check the prosthesis

for scratches and built-up protein‣Refer patient to their

ocularist if longer than 1 year since last polish‣Check the socket for

irritation, excess mucosal drainage and tissue complications

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Lubricants‣ Artificial eye wearers may

occasionally experience dryness, irritation, and difficulty blinking‣ Adverse weather, dust, wind and

air-conditioning tend to evaporate moisture from the front of the prosthesis‣ Silicone lubricants can be applied as

needed, typically morning and night - swipe on with finger‣Water-based eye drops can also be

applied as needed, typically every 2-3 hours

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Patient ResultsC

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Lubricants‣ Artificial eye wearers may

occasionally experience dryness, irritation, and difficulty blinking‣ Adverse weather, dust, wind and

air-conditioning tend to evaporate moisture from the front of the prosthesis‣ Silicone lubricants can be applied as

needed, typically morning and night - swipe on with finger‣Water-based eye drops can also be

applied as needed, typically every 2-3 hours

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Patient Results

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Blake

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Restoration

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AN

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Restoration

TH

AN

K YO

U

TH

AN

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U

RESTO

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TH

AN

K YO

UThank You!

12911 120th Ave NE, Suite C-10Kirkland, WA 98034

425.823.1861 [email protected] 888.257.0770

Todd Cranmore BCO/BADOLicensed Ocularist

www.ericksonlabs.com

Custom Prosthetic Eyes - WAEPS · ocular prosthesis. A HELAING ART PATIENT RESULTS CARE & HANDLING...

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Transcript of Custom Prosthetic Eyes - WAEPS · ocular prosthesis. A HELAING ART PATIENT RESULTS CARE & HANDLING...