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 Table of Contents  
CASE REPORT
Year : 2018  |  Volume : 7  |  Issue : 1  |  Page : 38-41

Improving the ocular esthetics of a patient with custom-made ocular prosthesis fabricated using digital photograph


1 Department of Maxillofacial Prosthodontics and Implantology, Rishiraj College of Dental Sciences and Research Centre, Bhopal, Madhya Pradesh, India
2 Department of Maxillofacial Prosthodontics and Implantology, Peoples College of Dental Sciences and Research Centre, Bhopal, Madhya Pradesh, India
3 Department of Prosthodontics, Rajarajeswari Dental College and Hospital, Bengaluru, Karnataka, India
4 Department of Periodontology, Rishiraj College of Dental Sciences and Research Centre, Bhopal, Madhya Pradesh, India

Date of Web Publication11-Jun-2018

Correspondence Address:
Dr. Sunil Kumar Mishra
Department of Maxillofacial Prosthodontics and Implantology, Peoples College of Dental Sciences and Research Centre, Bhopal, Madhya Pradesh
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/jdas.jdas_41_17

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  Abstract 


The exact matching of the artificial eye prosthesis with contralateral eye is the main aim of any maxillofacial prosthodontist to achieve adequate esthetics. Ocular prosthesis can be given as stock eye shell or by modifying a stock eye by making an impression of the ocular defect. Another method is a fabrication of custom-made eye prosthesis by sclera painting or using digital photograph. Advantages of custom-made eye prosthesis are well established over stock eye shell so, this article presents a case report of patient-wearing stock eye shell with poor esthetics, and the same was replaced with custom-made eye prosthesis fabricated using an image taken with the digital statutory liquidity ratio camera to gain the superior ocular esthetics.

Keywords: Custom-made eye prosthesis, digital imaging, geriatric iris, ocular defect, stock eye shell


How to cite this article:
Tomar BS, Mishra SK, Chandu G S, Chowdhary R, Singh S. Improving the ocular esthetics of a patient with custom-made ocular prosthesis fabricated using digital photograph. J Dent Allied Sci 2018;7:38-41

How to cite this URL:
Tomar BS, Mishra SK, Chandu G S, Chowdhary R, Singh S. Improving the ocular esthetics of a patient with custom-made ocular prosthesis fabricated using digital photograph. J Dent Allied Sci [serial online] 2018 [cited 2019 Oct 21];7:38-41. Available from: http://www.jdas.in/text.asp?2018/7/1/38/234188




  Introduction Top


A multidisciplinary management and team approach are essential in providing accurate and effective rehabilitation of ocular defect and follow-up care for the patient. The combined efforts of the ophthalmologist, the plastic surgeon, and the maxillofacial prosthodontist are essential to restore the patient's quality of life.[1]

Several techniques have been used in fitting and fabricating artificial eyes such as fitting a stock eye, modifying a stock eye by making an impression of the ocular defect, and the custom eye technique.[2],[3],[4] Literature presents the use of the stock eye for the replacement of ocular defect, but still custom-made eye prosthesis offers an excellent esthetics. Stock ocular prostheses are produced in mass, but it is not made to fit to a particular patient. The main problem with stock eye shell is inability to achieve the exact color matching with the contralateral iris. Sometimes, the iris portion matches, but exact color match of the sclera was not obtained with the adjacent eye.[3] Custom-made eye prosthesis provides more esthetic and precise results due to an exact matching of the sclera and iris to the contralateral eye and also impression made establishes the exact contours of the orbital defect. Iris painting in the presence of the patient seems to provide the long-term clinical results. Although this procedure is a trial and error approach and more time-consuming, the esthetic and functional results obtained justify the extra effort.[5]

This article describes a case report of the patient-wearing stock eye shell with poor esthetics, and the same was replaced with custom-made eye prosthesis fabricated using an image taken with the digital statutory liquidity ratio (SLR) camera to gain the superior ocular esthetics.


  Case Report Top


A 60-year-old male patient reported to the Department of Prosthodontics, with a chief complaint of unsatisfactory esthetics with his stock eye [Figure 1]. The patient gives a history of traumatic injury and surgical enucleation of the right eye ball [Figure 2] followed by rehabilitation with a stock ocular prosthesis. On examination of the stock eye prosthesis, it was found that the iris and sclera colour failed to match with the contralateral eye. The patient expressed his unhappiness and concern with the stock eye prosthesis and wants it to be replaced with a new prosthesis with improve esthetics and function. It was decided to fabricate a custom-made ocular prosthesis to meet the esthetics demand of the patient. The entire treatment planned was explained to the patients along with the limitation of the technique, and consent was obtained from him.
Figure 1: Patient with old stock ocular prosthesis

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Figure 2: Ocular defect

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Impression of the external surface of the defect was made with polyvinyl siloxane putty consistency (Reprosil, Dentsply, USA) impression material [Figure 3] and the impression was poured after beading and boxing procedure in Type III Dental Stone (Gyprock, Rajkot, India), and cast was obtained [Figure 4]. A special tray was fabricated with a disposable syringe attach to it on the primary cast [Figure 5]. Escape vent was made in the special tray and tray adhesive (Caulk, Dentsply, USA) was applied to it. Regular viscosity addition silicone (Reprosil, Dentsply, USA) was loaded into the syringe and injected into the eye socket [Figure 6]. The patient was instructed to make muscular movements of the eye to get functional impression of the socket. The final impression was removed from the socket and checked for accuracy [Figure 7]. Boxing of the impression was done and poured to get a two-piece split cast mold. A wax conformer was obtained by pouring the molten modeling wax (Hindustan, Hyderabad, India) poured in to the mold [Figure 8]. After lubricating the socket to avoid tissue irritation, wax conformer was tried in the patient orbital socket, and the size, comfort, the eyelid support, and the simulation of eye movement was evaluated. The flasking and dewaxing of the wax conformer was done and packing of the mold was done with tooth-colored heat cured acrylic which was selected after matching with the contralateral sclera of the eye. Curing and polishing are done to obtained acrylic scleral shell. The color and contour of the fabricated acrylic scleral shell were checked [Figure 9]. The dimension and color of the iris were matched and marked according to the contralateral eye. In this technique as per the size of iris, the fabrication of the corneal button with stud was done with clear acrylic resin [Figure 10]. A photograph of patient's normal eye was taken with a digital SLR camera, and the size of the photograph was adjusted according to the size of patient's normal iris. The photograph was checked for color accuracy against the contralateral eye. A drop of glue was placed on the photograph, and the corneal button was gently slid on top of the photograph to avoid air entrapment and kept it for drying. The iris disk attached with corneal button was placed in the centered position of the prepared scleral shell, as per the markings and sealed with the glue. The stud attached to corneal button was removed. Conjunctival effect was given with a thin layer of wax placed over the surface of scleral shell. The scleral shell was flasked, and dewaxing was done. Silk thread red color was glued to the sclera portion of the shell to simulate the capillaries. The mold-containing scleral shell was packed with heat-cured clear acrylic resin (Dentsply, USA). The curing of the prosthesis was done and finally it was finished and polished [Figure 11]. The custom-made eye prosthesis was evaluated in the socket for proper fit and comfort to the patient [Figure 12].
Figure 3: Preliminary impression

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Figure 4: Preliminary cast

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Figure 5: Special tray with syringe attached

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Figure 6: Final impression of the defect

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Figure 7: Final impression

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Figure 8: Wax conformer

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Figure 9: Acrylic scleral shell

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Figure 10: Corneal button with stud

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Figure 11: Finished prosthesis

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Figure 12: Postoperative view

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  Discussion Top


The problem with the stock eye prostheses were poor adaptation between the prostheses and the surface tissues which leads to constant irritation with chronic discharge and laxity of the lower eyelid in long-term use due to distribution of weight unequally.[6] Since the patient was already wearing stock eye prosthesis and was very unhappy with esthetics results, so it was decided to fabricate custom-made eye prosthesis. The disadvantages of stock eye prosthesis reported in literature were also found in the patient, such as there was no proper eyelid support, no exact color match to contralateral eye, and poor fit of the prosthesis.

A well fabricated and properly designed ocular prosthesis maintains its orientation while performing different movements by the patient. As the material science advances there was development of newer materials, with the help of which the impression of socket can recorded accurately and custom-made ocular prosthesis of exact fit and esthetics can be fabricated.[7] It was decided to fabricate custom-made prosthesis to overcome the drawbacks of stock eye prosthesis. Initially, the custom-made eye prosthesis was made with iris painting technique, but unfortunately, the result obtained was not up to satisfaction of the patient, so it was decided to make a custom-made eye prosthesis using digital photograph technique.

Digital imaging for the fabrication of the custom-made ocular prostheses has several advantages in comparison to the conventional painting method. In digital technique, as the exact image and color of the contralateral iris was used, there was exact color matching of the iris with high and acceptable esthetic results.[5] The patient was very happy as there was good improvement in the prosthesis with proper eyelid support. The technique described in this case report is very simple with decreases treatment time, and minimal artistic skills required in comparison to the iris painting technique.


  Conclusion Top


Mass produced commercial available stock eye shells have been marketed since years with less clinical success. The custom-made ocular prosthesis proved to be a boon to the patients needing ocular prosthesis. Digital photography technique provides a simple technique with better esthetic results in patients with high-esthetic demands for fabricating ocular prostheses.

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

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
Mishra SK, Chowdhary R. Reproduction of custom made eye prosthesis maneuver – A case report. J Dent Oral Hyg 2009;1:59-63.  Back to cited text no. 1
    
2.
Taicher S, Steinberg HM, Tubiana I, Sela M. Modified stock-eye ocular prosthesis. J Prosthet Dent 1985;54:95-8.  Back to cited text no. 2
[PUBMED]    
3.
Rao SB, Akki S, Kumar D, Mishra SK. A novel method for the management of anophthalmic socket. Adv Biomed Res 2017;6:72.  Back to cited text no. 3
[PUBMED]  [Full text]  
4.
Benson P. The fitting and fabrication of a custom resin artificial eye. J Prosthet Dent 1977;38:532-8.  Back to cited text no. 4
[PUBMED]    
5.
Artopoulou II, Montgomery PC, Wesley PJ, Lemon JC. Digital imaging in the fabrication of ocular prostheses. J Prosthet Dent 2006;95:327-30.  Back to cited text no. 5
[PUBMED]    
6.
Raizada K, Rani D. Ocular prosthesis. Cont Lens Anterior Eye 2007;30:152-62.  Back to cited text no. 6
[PUBMED]    
7.
Doshi PJ, Aruna B. Prosthetic management of patient with ocular defect. J Indian Prosthodont Soc 2005;5:37-8.  Back to cited text no. 7
  [Full text]  


    Figures

  [Figure 1], [Figure 2], [Figure 3], [Figure 4], [Figure 5], [Figure 6], [Figure 7], [Figure 8], [Figure 9], [Figure 10], [Figure 11], [Figure 12]



 

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Discussion
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