Procedure Eye Prosthesis*Iowa Eye Prosthetics*Board Certified Ocularist*Plastic Artificial Eye*Human* 

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Procedure for Scleral Shell Prosthesis

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Vaune M. Bulgarelli

 

David M. Bulgarelli

 

Susan Hartman

 

Custom Fitting, Coloring and

Fabricating Each Plastic Artificial Eye

 

Contents of these pages are copyrighted and may not be reproduced in part or its entirety in any form for financial gain, without written consent from Iowa Eye Prosthetics, Inc.

  

 

Brief Outline Of Our Special Artificial Eye Procedures

 

 

We are frequently asked to describe the method in which we fabricate plastic artificial eyes. This is our attempt to do this in as brief and concise manner as possible.

We fit plastic artificial eyes by a very special Modified Impression Method, perfected and improved by us since 1953. It results in a prosthesis with the best possible appearance and with most comfort. The superiority of this method makes it possible for surgeons to use the latest, sophisticated implants in the eye removal surgery knowing it also offers the greatest safety to the eye socket tissues. It also offers the best transference of movement from whatever is available from the eye socket. This may be only minimal if there is no implant, or moderate to excellent with various types of implants.

We require that adequate healing take place before fitting with the plastic eye. Schedule permitting, we will fit the prosthesis at six to eight weeks after surgery.

The patient fills out a registration form which is the beginning of a record similar to any kept by a practitioner.

An impression of the shape of the space in the eye socket is made with alginate, which sets up within 1 minute without discomfort to the patient, until it has a consistency similar to the white of a hard boiled egg. After removal from the eye socket, a two piece mold is made around it with dental stone, a material very much like Plaster of Paris. The impression material is removed and a molten hard type of wax is poured into the mold and allowed to cool and harden. After opening the mold, this wax piece constitutes a pattern for the artificial eye which can be changed in shape on the front surface and edges to improve the appearance and comfort of the piece by removing or adding wax where desired and the posterior surface irregularities are softened but retained for comfort and motility.

A plastic piece similar to the pupil, iris and cornea of the front of the eye, as near the color of the patient's living eye as possible, is chosen and this is built into the wax pattern. It can be removed and replaced in a different position on the pattern in order to give the proper effect of direction of gaze and vertical and horizontal positions as well as to give the desired prominence to the artificial eye and to create the proper opening of the eyelids. This part of the procedure usually takes several hours during which the patient must remain available at 10-20 minute intervals for trial fittings.

When all the improvements possible have been made in the wax pattern, a new, final mold of dental stone is made around it in a strong bronze flask. The wax pattern is removed, and the pupil-iris-cornea piece is placed back in the mold exactly where it had been in the wax pattern. A dough of white plastic (acrylic) is packed in the mold and processed by heat and pressure until it is cured and hardened. This, then, constitutes the beginning of the final plastic eye.

A thin layer of plastic is ground, filed and sanded from the front surface of the eye so that, after tinting with color and placement of red cotton threads to simulate blood vessels, a protective layer of transparent acrylic can be cast over the front surface to bring the form back to exactly the shape of the final wax pattern.

The coloring of the eye is done with the greatest care to match the companion eye and to present an appearance of living tissue. This is done by a method devised by us in October, 1976 and used exclusively by us and a few of our former apprentices. The patient must be present for this part of the work for perhaps three or more hours. During the painting, the prosthesis can be made to have its final shape and to look as if completely finished. It can be placed in the patient's eye socket to be judged with all illusions present, then removed and the coloring altered. This step can be repeated until the coloring is fully satisfactory.

When the color is judged to be correct, the eye is returned to the final mold and a layer of transparent acrylic is cured on its front surface to protect the color during polishing and wearing.

The finished, highly polished prosthesis is placed in the eye socket and judged in all respects. If it is not right in every way, changes can be made until it is not possible to improve it further.

This whole procedure takes 2 days ordinarily. If the eye socket is a very difficult one to fit, it might take 1 or 2 days more. While most other eye fitters take less time, we find that we can produce far superior prostheses, in all respects, by using this time consuming, painstaking method.

 

 

 

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