Dysfuntional Globes

Extreme Exophthalmic Globe

Attempts to diminish the appearance of an obtrusive dysfunctional eye without resorting to enucleation or evisceration had been to surgically narrow the aperture with sutures (canthoplasty). This however, would cause further distortion of the eyelid aperture and on occasion cause pressure on the bulbous eye. The following case presentation displays such an anomaly and how it was managed with a partially hand painted scleral prosthesis to first simulate catoptric (light reflex) image balance. The exophthalmic globe with its cover shell prosthesis was then complemented with a minus power lens (cosmetic optics).

This patient did not want to have either surgical correction of the deviated supra-esotropic eye, or removal of the blind exophthalmic right globe even though it was causing an abnormally wide eyelid aperture. Another existing cosmetic problem was that the eye had a dilated pupil with a pronounced cataract.

Frontal gaze demonstrates the wide palpebral aperture and deviated globe.

The anterior projection of the disfigured globe is quite apparent when viewed during its upward gaze.

The thin scleral cover shell prosthesis after being fitted with a catoptric imaged hand painted (over size diameter) iris will optically diminish the prominence of the eye when a properly prescribed minus power lens is worn. The hand held minus 4 power lens has already shown improvement in facial balance.

The bulbous eye's cornea/iris was supra-esotropic, but the scleral color and vascular pattern were normal in appearance. This visual impairment was whited out on the scleral cover shell and an iris was painted to align with the fellow eye allowing the balance of the prosthesis to remain in clear acrylic measuring less than one half of a millimeter.

Dysfuntional Globes Cont.

Extreme Exophthalmic Globe with Hypersensitive Cornea (Conjunctival Flap)

This young boy was born with an oversized globe with a sensitive cornea that could not tolerate a cover shell. The parents did not want him to lose the eye even though it was blind and unsightly, but still wanted him to have an improved appearance. conjunctival flap was performed to cover the cornea, thereby desensitizing it. The next step was to fit a very thin scleral cover shell type prosthesis with a slightly larger iris diameter to give the illusion of palpebral fissure symmetry even without cosmetic optics.

The exophthalmic right eye with a corneal conjunctival flap also shows inflammation of the conjunctival tissues following the flap procedure. This shows frontal and upward gaze.

The exophthalmic right eye with the flush fitting scleral prosthesis matches the normal scleral white, tints and vascular pattern with an oversize iris to also give balance to the eye aperture. The irregular conjunctival flap surface aids in producing responsive motility to the overlying flush fitting scleral cover shell prosthesis.

Note how the flush fitting scleral shell is synchronized with lateral excursion of the fellow eye. To make the cover shell prosthesis less detectable the peripheral edges in the horizontal plane are 'feathered' from the scleral white to clear acrylic to blend in with the underlying conjunctiva in the canthi.