Aesthetic Rehabilitation with Ocular Prosthesis - A Case Report

It is obvious that a person suffers from severe emotional, social, and psychological trauma when an eye is lost due to any reason. After evisceration, custom made ocular prosthesis can be used to improve facial aesthetics as well as social representation of that person. It is always a challenge to properly fabricate an alternate to the lost eye. But after fabrication, it certainly improves psychological satisfaction of the patient. In this case report, it is attempted to show how a patient was aesthetically rehabilitated with an ocular prosthesis. Key words: Ocular prosthesis, Ocular conformer, Scleral shell.

The Bubble Eye Sign: Understanding the Radiological Imaging of Gas inside the Orbit

Gas, appears as radiolucent on X-ray, is normally absent in the orbit. However, intraocular surgeries occasionally utilize retained intraocular gas for tamponade effect. Intravitreal gas persists after retinal surgery, being confounded by the scleral shell of the operated eye, outlines the shape of the eyeball, and gives the characteristic bubble appearance on skull X-ray. This is different from orbital emphysema caused by orbital fracture when gas is located outside the globe but confined by the orbit, giving a crescent or concave shape over the superior orbit usually. Falls is common after intraocular retinal surgeries due to change of usual stereopsis, prolonged prone posturing, and other systemic comorbidities. By identifying the “Bubble Eye sign” described, attending physician should alert the presence of intravitreal gas, most commonly iatrogenic. Further ophthalmological history taking and examinations are thus indicated, instead of exposing patients to unnecessary radiation under computed tomography scan for orbital fracture investigation.

Ocular Manifestation of Elizabethkingia Meningoseptica

Background: Elizabethkingia is a Gram-negative, obligate aerobic, oxidase positive bacillus that is known to cause a variety of nosocomial infections and has emerged as an important pathogen because of multiple anti-microbial resistance. We present the largest case series of Elizabethkingia ophthalmic infections, with specific emphasis on its clinical spectrum, risk factors, treatment and outcome.Method: Microbiological specimens growing Elizabethkingia were reviewed retrospectively at a regional tertiary hospital from 2005-2019. Clinical manifestation, risk factors, treatment including types of antibiotics, treatment duration and clinical outcome were documented. Results: Ten cases of culture positive Elizabethkingia ophthalmic infection were identified, which all cultured E. meningoseptica. Four cases keratitis, three cases of conjunctivitis, two cases of blepharitis and one case blepharitis-conjunctivitis were observed. Four cases were found to be associated with contact lens use and were found to colonize E. meningoseptica. One case of blepharitis was associated with and ocular prosthesis (scleral shell) an eviscerated eye. Fluoroquinolone and chloramphenicol were most commonly used topical antibiotics for treatment. The mean treatment duration for all infections was averaged at 6.5 weeks. Conclusion: E. meningoseptica is found to be the predominant species that has caused infection at the ocular surface. Contact lens use and ocular prosthesis appears to be a risk factor for infection due to ocular surface barrier disruption and bacteria colonization. Combination of fluroquinolone and chloramphenicol is a safe and effective treatment against Elizabethkingia ocular infections. Further studies are required to determine the susceptibility of commonly used topical anti-microbial agents to Elizabethkingia species.

Evisceration Versus Enucleation Following Ocular Trauma, a Retrospective Analysis at a Level One Trauma Center

Introduction Penetrating and perforating ocular trauma is often devastating and may lead to complete visual loss in the traumatized eye and subsequent compromise of the fellow eye. Enucleation is commonly utilized for management of a non-salvageable eye following penetrating and perforating ocular injuries. Recently, the use of evisceration for non-salvageable traumatized eyes has increased. As a technically easier alternative, evisceration offers several advantages to the ocular trauma surgeon to include faster surgical times, better cosmesis and motility, and improved patient outcomes. Debate still persists concerning whether or not evisceration is a viable option in the surgical management of a non-salvageable eye following ocular trauma given the theoretical increased risk of sympathetic ophthalmia and technical difficulty in construction of the scleral shell with extensive and complex corneoscleral lacerations. A retrospective analysis at a level 1 trauma center was performed to evaluate the practicality of evisceration in ocular trauma. Materials and Methods Eyes that underwent evisceration or enucleation following ocular trauma at San Antonio Military Medical Center, a level 1 trauma center, between 01 January 2014 and 30 December 2016 were examined. Factors evaluated include mechanism of injury, defect complexity, ocular trauma score, and time from injury to surgical intervention. Surgical outcomes were assessed. Results In total, 29 eyes were examined, 15 having undergone evisceration and 14 enucleation. The average size of the scleral defect before evisceration was 20 mm in length, and 23 mm before enucleation. The mechanism of injury and characterization of the defects among the two groups were relatively similar and described. Overall comparison of the two study groups in terms of surgical outcomes and complications was also relatively similar, as demonstrated. No cases of postoperative persistent pain, sympathetic ophthalmia, infection, or hematoma were identified for either group. Conclusions The postoperative outcomes demonstrated for the evisceration group are comparable to enucleation, which is consistent with the recent literature. Defect size and complexity did not affect surgical construction of the scleral shell during evisceration. If consistently proven to be a safe and viable alternative to enucleation, evisceration can offer shorter surgical times and better cosmesis for patients. More research into the long-term complication rates and more cases of evisceration for use following ocular trauma should be assessed. Still, this analysis demonstrates that evisceration is a viable surgical alternative and perhaps superior to enucleation for the management of a non-salvageable eye following extensive ocular trauma in many cases.