This information has been drawn together with Ocularists throughout the globe and should be used as a guide only. Individual circumstances may require a personal consultation with an Ocularist in your area.
What is an artificial eye and what does it do?
An artificial eye (eye prosthesis, ocular prosthesis) is a solid, seamless, non-permanent, removable-implant (FDA class 1 device) that serves to replace the lost orbital volume when the living eye is either shrunken or surgically removed. The visible surface of the prosthesis is designed to appear very lifelike, attempting to match the companion eye, if one is present. Although an ocular prosthesis does not have vision of its own, a prosthetic eye is medically necessary for many reasons, the most common are: enabling a sighted-companion eye to see and function better by eliminating negative symptoms of sympathetic-opthalmia (the condition where the health of one eye / eye socket either helps or harms the health of the companion eye / eye socket), eliminating physical stress caused by facial imbalance of the eyelids, eliminating the recurrence of chronic infection characteristic of a compromised eye socket, halting anatomical asymmetry and disfigurement by inhibiting the skull and surrounding tissue from migrating into a recessed eye socket and, in the case of a child, enable the skull, sinuses and facial tissue to grow proportionally and properly. However, the most obvious medical benefit to patients wearing eye prostheses is the restoration of natural facial anatomy.
What’s the difference between “stock” and “custom” eyes?
“Stock” or “ready-made” ocular prostheses are mass-produced. Stock eyes are no longer used in developed nations due to the many problems with them. Since a “stock eye” is not made for any particular person, it doesn’t fit any particular patient and therefore is uncomfortable, often creating harmful clinical issues such as infection. A “custom” ocular prosthesis, on the other hand, is made by your Ocularist to fit you and you alone.
What is an Ocularist?
An Ocularist is a carefully trained allied-health practitioner, skilled in the art of designing and fitting ocular prostheses. In addition to creating eye prostheses, the Ocularist educates patients on use and care of the prosthesis, also providing long-term care through periodic examinations and maintenance of the prosthesis.
Does medical insurance pay for artificial eyes?
If insurance coverage is available, most Ocularist offices will assist you in every possible way to obtain full benefits of your policy.
How long does it take to make an eye prosthesis?
Each Ocularist has their own timeline and particular way of creating prostheses. Also, each individual has their own unique issues, thus time is different for each patient. Some clinics may offer prosthesis fabrication as fast as two days, however, typically 3 to 5 appointments are normally required and span over a two to four week period for most patients.
What are the specific steps involved in making an artificial eye?
Generally there are five steps involved: 1) initial evaluation 2) impression molding (which is often done during the evaluation visit) 3) prosthetic model fitting with iris and sclera ocular anatomy design 4) fitting of the completed prosthesis and 5) a two week follow-up appointment for post fitting evaluation. After the completion of these appointments, follow up visits are necessary to monitor the health of the eye socket and to polish/resurface the prosthesis. These visits are typically every six months, but frequency varies per patient.
How long will my artificial eye last?
Socket and tissue changes naturally occur over time, which can effect the movement, comfort and appearance of your artificial eye. The integrity of the acrylic plastic material of the eye prosthesis will eventually breakdown and deteriorate, causing socket and lid irritation as well as excessive secretions and discomfort. The average patient needs to have their artificial eye replaced every 5 to 7 years; however this can vary person to person. There are some patients that have very sensitive systems and require a prosthesis every 3 years, while others can go as long as 10 years without experiencing too much discomfort from the micro-leaching of the plastic material. In the first few years modifications to your artificial eye can often be done by adding or removing plastic without replacing the whole eye. Young children will need adjustments and replacements more frequently as their faces size and shape is constantly changing.
How do I obtain an artificial eye?
Find a local Ocularist near you and contact them to make an appointment. Our “Find an Ocularist Page” is the most convenient method of contact and is found under the main menu.
Is it necessary to return to my Ocularist on a regular basis?
Yes. Modern standard of care dictates that patients require follow-up visits to monitor the health of the eye socket and to polish / resurface the prosthesis every three to six months. The “old world” standard of care was to allow the patient to remove the prosthesis themselves for cleaning, but this low standard of care brings with it continued inflammation, mucus discharge, infection, ill fitting prostheses and other clinical issues more serious in nature. However, in cases where the socket anatomy is compromised, such as the inability to blink or close the eye, different care protocol will apply and is best determined on an individual basis with patient follow up.
Over time your body’s tears build-up a protein plague on the surface of the prosthesis, making it dull and uncomfortable. As the deposits become heavy, it will irritate the lids and socket anatomy, causing extra secretions, and even pain. This is why it is medically necessary for an Ocularist to polish / resurface your prosthesis regularly. This will restore the shine to your artificial eye and also ensure that the eye socket remains healthy. Just as our own teeth build up a plague that a toothbrush cannot fully remove, the plague on the prosthesis cannot be fully removed by washing. This is why Ocularists are trained on specialized equipment and materials that are designed to properly remove this plague without damaging the prosthesis.
During your maintenance visits, your Ocularist will also evaluate your socket anatomy and the fit and appearance of your prosthesis, ensuring that it is always looking and feeling as good as possible. Only allow an Ocularist to polish your prosthesis. Opticians and other eye care professionals are not full time Ocularists and often damage prostheses, or at the very least, are not qualified to evaluate socket anatomy, fit, bacterial infiltration, fractures, prosthesis age, PMMA leaching and other factors that contribute to chronic exudate originating from an ocular prosthesis.
FAQs For Parents of Children With Prosthetic Eyes
Why does my child need an prosthetic eye after an eye loss?
Although an ocular prosthesis does not have vision of its own, a prosthetic eye is medically necessary for many reasons, the most common are: 1) enabling a sited-companion eye to see and function better by eliminating negative symptoms of sympathetic-opthalmia (the condition where the health of one eye / eye socket either helps or harms the health of the companion eye / eye socket), 2) eliminating physical stress caused by facial imbalance of the eyelids (comfort), 3) eliminating the recurrence of chronic infection characteristic of a compromised eye socket, 4) halting anatomical asymmetry and disfigurement by inhibiting the skull and surrounding tissue from migrating into a recessed eye socket and, in the case of a child, enabling the skull, sinuses and facial tissue to grow proportionally and properly, and 5) the most obvious medical benefit to patients and parents of pediatric patients is the restoration of natural facial anatomy.
Will it be difficult for my child to be fitted with an artificial eye?
The answer to this greatly depends on the temperment of the child. Each child is different in mood, personality, disposition and what they have gone through prior to proceeding with fabrication of an artificial eye. As with all patients, an impression molding of the patient’s eye socket needs to be taken. This is not a painful procedure, but the child is required to be relaxed and cooperative, not squeezing the eyelids. If this is not possible (and it usually is not for young children), the the impression must be taken during an “EUA” (Examination Under Anesthesia). During this appointment your child will under anesthesia for as little as 15 minutes. This procedure is usually done on an out-patient basis at a local hospital.
My child was born with a partially developed (microphthalmic) eye, is it possible to fit a prosthesis over such a globe?
Yes, and the proceedure is the same for a socket with no eye. Often thin ocular prostheses are called “scleral shell ocular prostheses.” These can be made to fit over any stage of microphthalmos. The early stage of microphthalmos may require a series of custom molded clear acrylic shapes (custom conformers) to gradually enlarge the orbital anatomy and palpebral fissure (eyelid margins) before a prosthesis that looks like and eye can be fitted.
What is the process of getting an ocular prosthesis for my child?
If this is a recent eye loss, you would be referred to an ocularist by your pediatric ophthalmologist, or primary care physician. Local, statewide and national healthcare insurers require this paper trail for approval of this service.
At what age should my child begin to wear an ocular prosthesis?
The steps to create a prosthesis should begin within a four to six weeks post-operative. In the case of a congenital anomaly (born without an eye(s) or a partially formed globe(s)) there would be a preparatory stage of custom conformers created in incremental sizes (in order to expand the eyelid margin and create space within the socket) prior to the fitting of the artificial eye. (This process can take anywhere from three months to three years, depending on the severity of the abnormal development of the bony orbital wall and the palpebral fissure aperture (eyelids).
How sensitive are the tissues under the eyelids where the prosthesis goes in?
The tissue sensitivity is similar to you putting a piece of hard candy into the mouth between the teeth and cheek.
Is it difficult for my child to adapt to wearing the prosthesis?
Young children can adjust to monocular vision and the wearing an artificial eye very quickly, as compared to adult prosthetic eye wearers who are readjusting from a lifetime of having depth perception. Wearing a prosthetic eye usually becomes a second nature to a child. If the eye was lost due to a trauma, it is the trauma that is far more difficult to adjust to then the acual wearing of the prosthesis.
How do I help my child remove and reinsert the prosthetic eye?
Your Ocularist will show you how handle the eye prosthesis. Instructions for removal and reinsertion can also be found on our website HERE.
Is there any cautionary advice you can give regarding the prosthesis and my child?
Yes. If your child is teething, be aware that they may remove the prosthesis and begin to bite on it (these small teeth marks can be polished off.) However, we also have had a few reports of children swallowing it. (If this occurs, you will have a diaper check, prior to having it disposed of or sterilized.) To date, there has been only one report in fifty years of a child choking on it where the Heimlich maneuver was applied.