Custom Prosthetic Eyes

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1 Custom Prosthetic Eyes Todd Cranmore BCO/BADO Licensed Ocularist WELCOME EYE CARE LOSS & HANDLING OCULAR PROSTHETICS SCLERAL SHELLS

2 Realities of Eye Loss Anxiety Depression Fear of Blindness Loss of Depth Perception Loss of 15-20% Peripheral Vision Life goes on... EYE LOSS OCULAR PATIENT PROSTHETICS RESULTS SCLERAL SHELLS

3 Eye Loss Conditions leading to a scleral shell Phthsical Eye Accident or Injury Retinal Detachment Glaucoma Corneal Dystrophy Infection Evisceration EYE LOSS OCULAR PATIENT PROSTHETICS RESULTS SCLERAL SHELLS

Evisceration Removal of the contents of the globe, leaving the sclera and extraocular muscles intact Indications: Endophthalmitis Improve cosmesis in a blind eye

4 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 EYE LOSS OCULAR PATIENT PROSTHETICS RESULTS SCLERAL SHELLS

5 Eye Loss Conditions leading to an artificial eye Trauma Blind, Painful Eye Ruptured Globe Tumors / Ocular Melanoma Diabetic Retinopathy Endophthalmitis Infection Enucleation EYE LOSS OCULAR PATIENT PROSTHETICS RESULTS SCLERAL SHELLS

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

6 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 EYE LOSS OCULAR PATIENT PROSTHETICS RESULTS SCLERAL SHELLS

7 Ocular Implants Solid Sphere Silicone Lucite Porous Sphere Hydroxyapatite (H-A, Coral, Bio-Eye ) Porous Polyethylene (Medpore, Porex ) Aluminum Oxide (Alumina ) Dermis Fat Graft EYE LOSS OCULAR PATIENT PROSTHETICS RESULTS SCLERAL SHELLS

conformer if edema has reduced Coloboma After 6-8 weeks post-op Coat s Disease Begin prosthesis when edema reduced Microphthalmia

8 Eye Loss in Children Ideal Schedule Trauma First visit 1-2 weeks post-op Retinoblastoma Persistent Hyperplastic Examine socket, fit custom conformer Primary Vitreous Every (PHPV) 2-3 weeks return for conformer check Retinopathy of Monitor Prematurity healing (ROP) Change conformer if edema has reduced Coloboma After 6-8 weeks post-op Coat s Disease Begin prosthesis when edema reduced Microphthalmia Anophthalmia EYE LOSS Meet with patient, explain process, ease anxiety Takes 3-4 appointments to complete prosthesis OCULAR PATIENT PROSTHETICS RESULTS SCLERAL SHELLS

9 Ideal Schedule 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 OCULAR PROSTHETICS SCLERAL SHELLS

10 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 OCULAR PROSTHETICS SCLERAL A HELAING SHELLS ART

11 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 OCULAR PROSTHETICS SCLERAL A HELAING SHELLS ART

5 minutes Important for the comfort and movement of

12 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 OCULAR PROSTHETICS SCLERAL A HELAING SHELLS ART

13 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 OCULAR PROSTHETICS SCLERAL A HELAING SHELLS ART

14 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 OCULAR PROSTHETICS SCLERAL A HELAING SHELLS ART

15 Attaching the Iris Flat plane with position marks Iris attached to blank with acrylic dough Blank with attached iris ready for veining OCULAR PROSTHETICS SCLERAL A HELAING SHELLS ART

Veining and Scleral Tint The silk thread is

16 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 OCULAR PROSTHETICS SCLERAL A HELAING SHELLS ART

17 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 OCULAR PROSTHETICS SCLERAL A HELAING SHELLS ART

18 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 OCULAR PROSTHETICS SCLERAL A HELAING SHELLS ART

Follow-up Schedule Scleral Shells Return after Fit over 2 months phthsical eye Any adjustments Up to full-sized are made globe for comfort, Alternative fit and/or to colored appearance contact Return

19 Follow-up Schedule Scleral Shells Return after Fit over 2 months phthsical eye Any adjustments Up to full-sized are made globe for comfort, Alternative fit and/or to colored appearance contact Return every Sometimes 6 months replaces Polish and need resurface for enucleation prosthesis Patient can wear fulltime and conjunctival Check fit tissue Excellent movement Replace prosthesis every 5 years OCULAR PROSTHETICS SCLERAL A HEALING SHELLS ART

20 Scleral Shells Fit over phthsical eye Up to full-sized globe Alternative to colored contact Sometimes replaces need for enucleation Patient can wear fulltime Excellent movement SCLERAL SHELLS A HEALING ART

21 Scleral Shells SCLERAL SHELLS CARE RESTORATION & HANDLING A HEALING ART

22 Scleral Shells SCLERAL SHELLS CARE RESTORATION & HANDLING A HEALING ART

23 Scleral Shells SCLERAL SHELLS CARE RESTORATION & HANDLING A HEALING ART

24 Scleral Shells SCLERAL SHELLS CARE RESTORATION & HANDLING A HEALING ART

Most patients wear their prosthesis full time, removing only occasionally to clean.

25 Scleral Shells Prosthetic Handling 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. SCLERAL SHELLS CARE RESTORATION & HANDLING A HEALING ART

26 Prosthetic Handling 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. A HEALING ART RESTORATION

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

27 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 PATIENT CARE RESULTS & HANDLING A HEALING ART RESTORATION

28 Removing a Prosthesis WITH FINGERS: 1) Pull down the lower eyelid with index finger, look up and slide finger towards the ear. WITH SUCTION CUP: 2) Allow the prosthesis to slide out over the lower lid. Gently remove prosthesis. PATIENT CARE RESULTS & HANDLING A HEALING ART RESTORATION 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.

Cleaning a Prosthesis 1) Wash hands with soap and warm water 2) Use warm water to rinse and softly scrub the prosthesis with your fingers 3) Only use soap when necessary - a

29 Cleaning a Prosthesis 1) Wash hands with soap and warm water 2) 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 PATIENT CARE RESULTS & HANDLING A HEALING ART RESTORATION

30 Inserting a Prosthesis WITH FINGERS: 1) Lift upper lid with index finger to create an opening. Gently slide top edge of prosthesis under upper lid. WITH SUCTION CUP: 2) Release upper lid once prosthesis is in. Pull down lower lid and blink until prosthesis sets into position. PATIENT CARE RESULTS & HANDLING A HEALING ART RESTORATION 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.

31 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 PATIENT CARE RESULTS & HANDLING A HEALING ART RESTORATION

32 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 PATIENT CARE RESULTS & HANDLING A HEALING ART RESTORATION

Lubricants Patient Results Artificial eye wearers may occasionally

dust, wind and air-conditioning tend to evaporate moisture from the

typically morning and night - swipe on with finger Water-based eye drops

33 Lubricants Patient Results 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 A HEALING ART RESTORATION

34 Patient Results A HEALING ART RESTORATION

35 a personalized approach to prosthetic eyes RESTORATION A HEALING ART Patient Results

36 Blake RESTORATION

37 Restoration RESTORATION

38 a personalized approach to prosthetic eyes RESTORATION THANK YOU THANK YOU THANK YOU Restoration

THANK YOU THANK YOU THANK YOU 12911 120th Ave NE,

39 Thank You! Todd Cranmore BCO/BADO Licensed Ocularist RESTORATION THANK YOU THANK YOU THANK YOU th Ave NE, Suite C-10 Kirkland, WA

Virtual Mentor American Medical Association Journal of Ethics December 2010, Volume 12, Number 12:

Virtual Mentor American Medical Association Journal of Ethics December 2010, Volume 12, Number 12: 950-954. IMAGES OF HEALING AND LEARNING The Fourth O in Eye Care Ocularists Michael O. Hughes, BCO The