Prosthetic Eye Plastic Surgery

Visual impression is the first and often a lasting impression about a person. The face, especially the eyes, largely conveys this impression. Injury as well as, certain disorders such as Cancers can lead to loss or removal of an eye. While the vision cannot be restored, the appearance can be brought back to near normal, by customized artificial eyes (prosthesis).

An artificial eye is a prosthesis or a device that fits within the socket, behind your eyelids. It mimics the natural eye, and is painted exactly like your natural eye. Insertion and removal is easy, and one has to clean it once a month. The eyelids can comfortably close on the artificial eye, giving it a natural look. Occasionally, if the pouch behind the eyelid (that holds the artificial eye) is shrunken, one may require a surgery prior to the fitting of an artificial eye.

After eye removal surgery, a prosthetic eye (sometimes referred to as a glass or synthetic eye) can help create a natural appearance, while at the same time protecting the new space formed through the procedure.

The prosthesis is a custom-made oval acrylic shell resembling your normal eye. Fine details such as the iris colour, pupil size, and even tiny vessels on the eye are incorporated to restore a natural appearance.

The ophthalmologist will fit your prosthetic eye about five weeks after surgery for eye removal. This timing is needed to allow all tissue swelling to resolve. A specialist, called an ocularist, makes the ocular prosthesis. Most people prefer a prosthetic eye over wearing a patch or bandage because it often looks very natural, and most people are not able to tell the difference between your prosthetic and natural eye.

Sometimes the eye socket develops problems after removal of the eye. Those problems can include drooping of the lower eyelid, a deep, hollow appearance to the lids, and scarring of the interior lining of the socket making it difficult to wear a prosthetic eye. The Oculoplastic surgeon can perform surgeries to address these problems, and permit the patient to enjoy a comfortable, cosmetically pleasing, and natural appearance.

Who is a Candidate?

If you have had your eye removed for some reason, you may be considering getting a prosthetic eye implanted to feel more comfortable with your appearance.

What to Expect

After your surgeon removes your eye, he or she will place an orbital implant – a sphere that is placed deep into the socket. This implant replaces the volume lost from removal of the eye. Most of these implants are made of a synthetic material called porous polyethylene or hydroxyapatite. Some are made of acrylic plastic. The surgeon may elect to wrap the implant with a material such as eye-bank (cadaver) so the prosthetic eye moves more naturally. The muscles that control movement of the eye are usually attached to the implant, which gives you as much movement of the artificial eye as possible.

The implant is then covered by your own tissues, and a clear thick contact lens (conformer) is placed at the time of surgery. A large pressure patch is placed over your eye for about one week. It should remain dry. Your doctor will remove this patch during your first post-operative visit, and then you will be instructed to use a prescribed antibiotic ointment between the eyelids every day. When you look at the socket, it will appear pink like the lining of your mouth.

The clear conformer stays in place for about four or five weeks, until it is time to make the prosthetic eye. This clear conformer can sometimes fall out on its own during this time. This is not an emergency. Simply call the surgeon’s office the next day, and an appointment will be made to have the conformer replaced in the socket.

Once your surgery has healed and all swelling has resolved, an ocularist (expert in the fabrication and fitting of ocular prostheses for people who have lost an eye) takes an impression of your eye socket to give your prosthesis the perfect fit, and paints the prosthesis to match as closely as possible your normal remaining eye. This process may take several days.

Your eye socket may continue to change shape after surgery. Additional fitting and adjustment of the prosthesis may be necessary for weeks, months, or years following initial placement. A new ocular prosthesis is needed about every five years, as the acrylic material eventually breaks down, and changes occur in the tissues and volume of the socket.

You should visit your ocularist and oculofacial surgeon every six months to have the prosthesis checked, cleaned, and polished, and to have the tissues behind the prosthesis checked to be sure there is no infection or inflammation of the socket. Good maintenance is the key to having a healthy comfortable socket with excellent cosmetic appearance for many years. Talk to your ocularist if you have questions about ways to continue to improve the fit and make it more comfortable.