|Year : 2020 | Volume
| Issue : 1 | Page : 40-42
Novel self-lubricating hollow ocular prosthesis: A multispecialty approach
Rahul Bahri, R Vijaya Kumar, Poonam Prakash, Kirandeep Singh
Department of Dental Surgery and Oral Health Sciences, AFMC, Pune, Maharashtra, India
|Date of Submission||20-Dec-2019|
|Date of Acceptance||27-Dec-2019|
|Date of Web Publication||31-Jan-2020|
R Vijaya Kumar
Department of Dental Surgery and Oral Health Sciences, AFMC, Pune - 411 040, Maharashtra
Source of Support: None, Conflict of Interest: None
Congenital or acquired ocular defects advocate the need for fabrication of ocular prosthesis to restore patients form and esthetics and also to boost the self-confidence of the patient. Solid ocular prosthesis maintains the shape of the remaining soft tissues in a healthy state. Larger defects require fabrication of hollow prosthesis which are lightweight, provides adequate support to adjacent tissues, protects the tissue bed, prevents laxity of eyelids thereby restricting drooping of lower eyelid. It also enables the treating clinician to utilize this hollow space for the incorporation of a lubricant, to prevent dryness of eyes and for the management of local symptoms. This article highlights a novel technique for the fabrication of a self-lubricating hollow ocular prosthesis.
Keywords: Hollow ocular prosthesis, reservoir, self-Lubricating
|How to cite this article:|
Bahri R, Kumar R V, Prakash P, Singh K. Novel self-lubricating hollow ocular prosthesis: A multispecialty approach. J Dent Def Sect. 2020;14:40-2
|How to cite this URL:|
Bahri R, Kumar R V, Prakash P, Singh K. Novel self-lubricating hollow ocular prosthesis: A multispecialty approach. J Dent Def Sect. [serial online] 2020 [cited 2020 Apr 2];14:40-2. Available from: http://www.journaldds.org/text.asp?2020/14/1/40/276412
| Introduction|| |
Anophthalmia is a clinical condition characterized by the absence of contents of orbit. The management of such defects aims at rehabilitating the defect site, preserve the remaining tissue and provide a platform for normal growth of adjacent collapsed tissue among other benefits. This can be carried out surgically using orbital implants or prosthetically by fabrication of an ocular prosthesis. This case report highlights the fabrication of a self-lubricating hollow ocular prosthesis using a multidisciplinary approach for rehabilitation of acquired ocular defect.
| Case Report|| |
A 41-year-old serving soldier reported with a chief complaint of unesthetic appearance due to loss of the right eye since 4 years. The patient sustained injury to his right eye in a grenade blast during routine practice session following which enucleation was done. History also revealed that a custom made ocular prosthesis was fabricated 1 year back, but it caused irritation to eye on prolonged use and was hence uncomfortable to the patient. Based on history and clinical examination, a diagnosis of anophthalmia secondary to enucleation was made and it was decided to rehabilitate the defect using a self-lubricating hollow ocular prosthesis with reservoir.
Custom made perforated tray was fabricated in autopolymerizing clear acrylic resin. Light body consistency of polyvinyl siloxane was used to make impression of the defect site. The impression was invested and a two piece split mold was obtained. Molten white carving wax (2GM, India) was poured in the mold and wax pattern was obtained and try in was done. Digital vernier caliper was used to measure the relation of iris to adjacent soft-tissue landmarks. A multidisciplinary approach different from conventional protocol was used for the selection of iris. The assistance of ophthalmologist was sought and a Huvitz HIS 5000 U slit lamp microscope (Huvitz Co. Ltd., Korea) with AT 900 Haag streit Goldmann applanation tonometer (Haag Streit, USA) was used to visualize, analyze, and record the contralateral healthy eye [Figure 1]. This image was printed on a high-quality photographic paper (Kodak 180 GSM, Eastman Kodak Company, India). The iris obtained was cut out and placed over the wax pattern and secured with iris button. The position was checked at natural gaze position in the patient's eye.
The pattern was invested in a specialized miniature flask. Once dewaxing was done, the flask was opened, two orientation notches were marked in the flask, and a paper pin was placed over it. A double sheet of modeling wax was adapted to both parts of the flask. Putty was placed with the paper pin in the orientation notches and flask was closed. Once it was set, the flask was opened and putty index was retrieved. Dewaxing was done and checked for uniform space around the index. N1 shade scleral polymer heat polymerized acrylic resin was selected. The material was packed at both parts of flask, putty index was placed and flask was closed. Before the material was fully set, the flask was opened, flash removed, and putty index was removed. A small amount of resin and monomer was placed at notches to improve bonding. Bench curing was done and manufacture recommended curing cycle was followed as per standardized protocol. The hollow prosthesis was obtained, finished, and polished. Fine acrylic bur was used to create a hole into the reservoir cavity at the posterosuperior margin on the intaglio surface. Rubber plunger from insulin syringe was placed in such a way that it occludes the hole without leaving any space around the plunger and also acts as a control system for the extrusion of lubricant from the hollow part [Figure 2]. Carboxymethylcellulose lubricant gel was used to fill the reservoir and the prosthesis was tried in patient [Figure 3].
The patient was trained to do forceful blinking and applying slight finger pressure over the eye of defect site to allow lubrication of the eye. Finally, the prosthesis was obtained and characterization was done using red flocking fibers. Monopoly syrup was prepared and the cameo surface was coated to a uniform thickness. The prosthesis was inserted in the patient and checked for functional movements of the eye [Figure 4]. Post insertion instructions regarding cleaning and maintenance of prosthesis were explained to the patient. Recall appointments were scheduled for 24 h, 3 days, 1 week, and 1 month for adjustment of prosthesis as required. The patient was contented with the prosthesis.
| Discussion|| |
Various materials and techniques have been mentioned in literature for prosthetic rehabilitation of ocular defect. The selection of iris is an important step for esthetic outcome. Methods used for making of iris, include iris painting method, using stock eye, and digital imaging techniques. A novel technique was used in rehabilitation of anopthalmic defect by use of a slit lamp microscope for making of a more accurate and precise iris simulating the size and color of the contralateral normal side eye. In the present case, we used Huvitz HIS 5000 U slit lamp microscope with a Goldmann applanation tonometer (Haag Streit, USA). This equipment is used widely in ophthalmology to note changes in anterior chamber of eye and can be used to capture external image of a healthy eye.
Hollow ocular prosthesis results in more physiologic support to adjacent soft tissue and prevents drooping of eyelid and ptosis. Dryness of eye is the most common complaint in patients rehabilitated with ocular prosthesis. In addition, with frequent use of prosthesis, the surface becomes rough causing irritation to the tissues. Incorporation of a reservoir while designing can help alleviate these symptoms. A reservoir within the hollow prosthesis can be used to accommodate lubricant and also act as a vehicle for local drug delivery system. Various authors have advocated different techniques for fabrication of the same.,,,, In this case report, we have used rubber plunger of an insulin syringe which is commonly available and this was placed at posterosuperior aspect on intaglio surface of prosthesis to allow lubricant to flow into the defect site. Carboxyl methylcellulose is used as a lubricant because of its ability to moisten the eye, thereby protecting it from injury.
Specialized equipment available with ophthalmology specialty can be successfully utilized during prosthodontic rehabilitation of anophthalmic cases for fabrication of accurate, life like ocular prosthesis. In addition, a rubber plunger of an insulin syringe can be successfully used as a control system for dispensing of artificial tear/drug in an ocular prosthesis.
Declaration of patient consent
The authors certify that they have obtained all appropriate patient consent forms. In the form the patient(s) has/have given his/her/their consent for his/her/their images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
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[Figure 1], [Figure 2], [Figure 3], [Figure 4]