Custom-made Ocular Prosthesis for Rehabilitation of Missing Parts of the Face: A Case Report

Background. Eyes are an important component of the face and vital organs of vision. Eye loss can be caused by congenital defects, trauma, or tumor. Loss of an eye produces physical abnormalities that pose a psychological burden on the patient, as well as visual function damage. An ocular prosthesis is an artificial maxillofacial prosthesis to replace the lost eye. Case summary. A 54-year-old man consults at the Prosthodontics Specialist Universitas Airlangga Dental Hospital for an eye prosthesis. The patient did not have the right eyeball since birth. Soft tissue around the eye is normal, including the palpebral muscles. Case management. An impression was made using a custom tray and alginate in the defect area, followed by filling the impression with gypsum type 3 to get a working model, from which a wax model is made and adjusted to the patient. After that, sclera and ocular acrylic prostheses are made on the basis of an adjusted wax model. The prosthesis is then polished and colored according to the contralateral eye. Then the prosthesis is delivered to the patient. Conclusion. The hollow custom-made eye prosthesis can be considered in the treatment of anophthalmia. It is able to improve the patient's psychological and emotional status.

Effect of Rehabilitation with a New Ocular Prosthesis on Electromyography of the Occipitofrontalis, Temporal, Masseter, and Sternocleidomastoid

Objectives The aim of this study was to verify during facial expressions (“happy,” “sad,” “fearful,” “angry,” “surprised,” and “disgusted”) if: (1) there would be difference in the electromyography (EMG) of the occipitofrontalis, temporal, masseter, and sternocleidomastoid muscles on the normal side (NS) compared with the affected side (AS) (without the use of an ocular prosthesis) in individuals with unilateral absence of the eyeball, and (2) the rehabilitation with a new ocular prosthesis would affect the EMG of the muscles studied on the AS in these individuals. Materials and Methods Thirteen individuals, without temporomandibular disorder, with good health, with unilateral absence of the eyeball (the eye must have been removed by evisceration or enucleation), and users or nonusers of an ocular prosthesis were included. EMG of the occipitofrontalis, temporal, masseter, and sternocleidomastoid muscles was performed during rest and facial expressions (“happy,” “sad,” “fearful,” “angry,” “surprised,” and “disgusted”) before (T0) and 90 days after (T1) rehabilitation with a new ocular prosthesis. The analyses were performed in T0 on NS and AS (without the use of an ocular prosthesis), and in T1 on AS with the new ocular prosthesis. Statistical Analysis All data were submitted to the Student's t-test with p < 0.05. Results There was no statistically significant difference comparing the AS with the NS in T0 for all muscles studied, during all facial expressions evaluated (p > 0.05). There was no statistically significant difference comparing the AS in T0 with itself in T1 for all muscles studied, during all facial expressions evaluated (p > 0.05). Conclusion Eye loss did not affect the EMG of studied muscles when comparing NS with AS (without the use of an ocular prosthesis). The rehabilitation with ocular prosthesis was not capable of changing the EMG on AS.

Should we care about the ocular surface in the anophthalmic patient?

Purpose: To assess clinical and biomolecular changes of the conjunctival epithelium in anophthalmic patients wearing an ocular prosthesis. Methods: Thirty-five unilateral anophthalmic patients were enrolled. Patients with blepharitis, lid abnormalities, and topical/systemic medication affecting the ocular surface were excluded. Symptom Assessment in Dry Eye (SANDE) questionnaire and tear function test (Schirmer Test Type I) were recorded. Conjunctival inflammation and meibomian gland dysfunction (MGD) were graded in the anophthalmic side and fellow eye. Impression cytology sampling of the upper, lower tarsal, and posterior/bulbar conjunctiva from the anophthalmic socket were collected and compared to healthy controls. Results: Patients had significantly higher SANDE ( p < 0.001), Schirmer I test ( p = 0.004), conjunctival inflammation ( p < 0.001), and MGD scores ( p < 0.001) on the anophthalmic side compared to the fellow eye. Mucin 5AC, inflammatory markers (MMP-9, ICAM-1) expression ( p < 0.001), and response to oxidative stress (NRF2-KEAP1 signaling pathway) ( p < 0.05) were significantly upregulated in the posterior conjunctival surface in the anophthalmic socket. Conclusions: Anophthalmic patients complained of more pronounced dry eye symptoms and presented more significant signs of inflammation and MGD on the anophthalmic side. The bulbar conjunctiva, behind the prosthesis, showed more significant hyperexpression of mucins, markers of inflammation, and increased response to oxidative stress compared to the tarsal conjunctiva. Patients wearing ocular prosthesis had signs of inflammation resembling dry eye disease.

FABRICATION OF OCULAR PROSTHESIS IN A SINGLE APPOINTMENT USING A CUSTOM PAINTED IRIS- A CASE REPORT.

Loss of any facial structure can have a deep social, physical and psychological impact on the patient. Rehabilitation of such patients with ocular prosthesis helps to overcome not only their psychological trauma but also social acceptance by restoring the lost facial structure and aesthetics of patient. The present article describes a method of fabricating ocular prosthesis in a single appointment by using conventional materials for acceptable t and optimum aesthetic treatment outcome

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.

Health related quality of life of patients treated with bilateral enucleation for retinoblastoma

Purpose: Bilateral enucleation is rarely used to manage retinoblastoma (Rb). We present the health-related quality of life (HQL) and the associated factors among individuals who underwent bilateral surgical enucleation for retinoblastoma. Methods: Patients were interviewed via telephone in January 2020. A retinoblastoma registry was used to select patients who underwent bilateral enucleation/exenteration during 33 years. Data included age, gender, literacy, occupation, marital status, and health issues. Patients were asked eight questions on HQL. The responses were graded as 0–10. The percentage proportion of the HQL score was correlated to the determinants. Results: Twenty-one out of 24 participants were interviewed (median age, 23 years). Fourteen participants answered the HQL question themselves, and for 7, their parents answered. Twenty patients (95%) had an ocular prosthesis. The median HQL score was 58 (out of a maximum score of 80) (interquartile range (IQR): 49; 70; minimum, 0 and maximum, 74). The HQL score was positively correlated to: self-reporting than parents reporting (Mann Whitney U (MW) p = 0.05); among students versus individuals in other occupations (MW p = 0.03); interval between eye removal and interview ( p = 0.02). Age at enucleation of the second eye ( p = 0.001), students ( p < 0.001), and self-responders ( p < 0.001) were independent predictors of a high HQL score. Conclusions: HQL of individuals having bilateral eye enucleation for retinoblastoma was reasonably good and positively correlated to self-reporting, learning as students to cope and age at 2nd eye removal. Anaplasty services to improve cosmetics seem to benefit such disabled persons.

Rehabilitation of an adolescent patient’s anophthalmic cavity with customized ocular prosthesis: a clinical report

The absence of an eyeball results in physical, psychosocial and functional alterations on an individual. Therefore, rehabilitation procedures are essential to repair the patient’s self-esteem, self-confidence and physiological features. The aim of this study is to describe a case of ocular prosthetic rehabilitation in a pediatric patient. A female teenager, 17 years old, was referred to the maxillofacial prosthetic clinic to replace her former prosthesis fabricated two years ago. The new ocular prosthesis was confectioned with termopolymerizable acrylic resin and hand painted with acrylic paint on a colorless acrylic ocular bottom. The prosthesis was installed and the instructions were explained. In teenage patients the prothesis must be elaborated as soon as possible with periodic replacements in accordance with the growth period. The awareness of legal guardians and patients is essential to the success of the treatment in pediatric patients. In the present case, the patient was satisfied with the aesthetic and functional outcome.