Frequently Asked Questions

What is an Ocular Prosthesis?

An ocular prosthetic or artificial eye replaces a missing natural eye following an enucleation or evisceration. The ocular prosthetic typically takes the shape of a convex shell. The prosthesis fits over an orbital implant and under the eyelids. Most ocular prosthetics today are made of cryolite glass or medical grade acrylic. A variant of the ocular prosthesis is a very thin hard shell known as a scleral shell which can be worn over an eviscerated or damaged eye. Makers of ocular prosthetics are known as ocularists. An ocular prosthetic does not provide vision. Someone with an ocular prosthetic is totally blind on that side and has monocular depth perception due to the loss of binocular vision.

An orbital prosthesis is the artificial replacement of the eye and eyelids for a person who underwent an exenteration. Ocularists and/or anaplastologists typically provide this service.

Four perspectives of an acrylic right ocular prosthesis.

Overview of construction

The core of an ocular prosthesis is the orbital implant. Today, modern orbital implants use porous materials to allow blood vessels to grow into them. The material of choice is currently hydroxiapatite or porous polyethylene, a synthetic alternative, which is of a similar composition to bone, and of a sponge like structure, allowing colonization of the implant by the body's cells. This decreases the likelihood of rejection by the body's immune system and allows for natural cleaning to occur. The optic nerve is cut beyond the implant. Four of the six muscles that allow movement of the eye are reattached to the implant; this allows for most of natural motion in the prosthetic. The orbital implant is covered with conjunctiva. Within the remaining space, the visible aspect of the ocular prosthetic is placed. It is this piece that is custom-created by an ocularist after the eye socket has healed from surgery. One could think of it as a giant painted contact lens. This is also the only removable piece. The prosthesis should be removed and cleaned regularly and professionally polished at least annually.

Immediately after surgery, a clear conformer is used in place of the prosthesis itself to hold the eyelids in place and to help the socket form during healing. It is of a generic shape; a very basic clear convex shell through which the conjunctiva can be seen. After the socket has been given time to heal, it is the duty of an ocularist to create a proper prosthesis. To do this, a mold is taken of the socket between the eyelids and the conjunctiva using a similar material to that used to create moulds of one's teeth. From the mould, a wax or acrylic prototype is created. This prototype is placed within the socket to determine if the thickness and shape will be appropriate. These attributes primarily influence how the eyelids rest when open; more thickness makes for a more open eye. Once the desired shape is reached, the position the pupil will be at is marked for later reference. Then, the final prosthetic is created in the desired material. This prosthesis is initially simply white with a built-in iris and pupil already painted and positioned on the prototype. Using the remaining eye as a reference, the ocularist then paints the veining and scleral shading. Using small threads, the blood vessels are added. Finally, the prosthesis receives a protective coating/sealant usually done in a clear acrylic.

A cross-section diagram of a prosthetic eye.

A prosthetic right eye, made from acrylic

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