Pankaj Kumar Singh, B.Optom

Consultant Ocularist, Global Prosthetic Eye Centre, New Delhi.

Summary  Congenital anophthalmia is a condition of eye abnormality which is characterised by the absence of one or both eyes. This clinical condition is also known as nanophthalmia which is characterized by a small or underdeveloped eye. Microphthalmia is an eye abnormality that arises before birth where one or both eyeballs are abnormally small. In some affected individuals, the eyeball may appear to be completely missing, however, even in these cases some remaining eye tissue is generally present. It is understood that this extremely rare disease is predominantly the effect of genetic abnormalities. Similar to anophthalmia, microphthalmia is predominantly the result of chromosomal abnormalities during foetal development. A recent study^1,2 has determined that anophthalmia and/or microphthalmia have been present in as many as 1 in every 10,000 live births.   Management Customised Ocular Prosthesis fabrication is a mandatory requirement for children with anophthalmia and microphthalmia. This treatment will include serial socket expanders with the help of conformers, see figure 1. Conformers are made of clear plastic and are fitted into.

Figure 1: Indicates the three stages of socket expansion with socket conformer

the socket to promote socket growth and expansion of socket tissues as well as the proper development of ocular adnexa such as orbit, eyelids.

Figure 2: Indicates the overall development of socket size with regular follow-up at the age of 4 years showing a normal prosthetic eye fitting.

The ocularist’s aim is to expand the underdeveloped eye socket as early as possible which later can be fitted with customised prosthetic eye, it is important to continually make adjustments to the prosthesis to ensure that the socket size keeps a good pace with the child’s overall development, see figure 2.

Role of parents

 In such cases the parents must keep trust on ocularist, and their role is pivotal. Parents are required to follow the instruction given by the ocularist during the period of expansion of socket size. Regular follow-up with the ocularist is essential in a frequency of every 3 to 6 months. As a parent, it is important that they should encourage their child to become familiar with their prosthesis as soon as possible. It is also important that parents of children with anophthalmia and microphthalmia should understand that restoration of eye socket with ocular prosthesis is a continuous process throughout childhood. The ocularist’s main goal in prosthetic ocular management for infants and young children is to stimulate and maintain normal eye socket development.   Brief description of manufacturing a customised ocular prosthesis

1.  An impression is taken with an impression tray with the help of alginate mixture.
2. After taking impression we take out the wax model replica of the impression taken.
3. Followed by wax trail inside the socket.
4. Later we make mould with the final wax trail.
5. Then in the same mould we fabricate the eye with acrylic resin along with the painted 3D iris button.
6. After that the eyes sclera is painted according to the patient’s colour of the sclera.
7. Finally colour of the sclera is coated with clear PMMA and polishing to give optimal shine and comfortable surface to wear the eye.

References

1. Ragge, N. K., Subak-Sharpe, I. D., & Collin, J. R. O. (2007). A practical guide to the management of anophthalmia and microphthalmia. Eye, 21(10), 1290-1300.
2. https://ghr.nlm.nih.gov/condition/microphthalmia#statistics (last accessed 18-06-2020; 11:00am)

Note – Consent was taken from the parents of the patient for taking and publishing picture. Pictures in this content was taken by Ocularist Pankaj Kumar Singh at the Global Prosthetic Eye Centre, New Delhi.