Results: Congenital Microphthalmia

This secondary embryonic stage aberration will show the early formation of an eyeball that may be pellet size to that of a small white pea. This is the scleral portion of the eye that aborted prior to the development of the cornea and iris. When the eyelids are separated there will be less of a funnel shape with this bud like globe at back of the orbit. There will also be the beginning of defined fornices that may help to retain a flush fitting stemmed conformer. (Note: If a stemmed conformer is used initially in this secondary stage it would only serve to prevent rotation of the flush fitting conformer.) Externally the eyelid development is also slightly more advanced by being less taut and more supple to the touch. The projected time before fitting the ocular prosthesis is usually between 6 months to a year.

This case presents a bilateral birth defect that advanced to microphthalmia. This child had two white pea sized globes which necessitated fitting flush impression molded expansion conformers rather than the empirically fitted 'trial and error' procedure used with congenital anophthalmia. The flush fitting conformers will eliminate any chance of causing pressure and/or discomfort to the partially formed globes while continuing to enlarge the orbital periphery, fornices and eyelid apertures.

Secondary Embryonic Stage (Definition of a Very Small Globe)

This young patient responded quite well to stem-less, molded clear acrylic conformers. This photo shows the first of three incremental sized conformers.

These bilateral prostheses were fitted in the seventh month. Note: The prostheses were made with mydriatic (dilated translucent) pupils, because the child had some light perception.

One advantage of being fitted with cover shell prostheses by your local ocularist, is that the proper fit can be monitored, adjusted or refitted when necessary. This photo was taken 6 years later.

RESULTS: Congenital Microphthalmia

This final embryonic stage aberration just falls short of being a normally developed functional eye. It is a miniaturization in all aspects with a micro-cornea and iris. The eyelids although narrower, will respond quite readily to 2 to 4 increased in thickness impression moulded flush fitting conformers. This usually is over a period of 3 to 6 months. (Note whenever there is definition of a globe especially with a clear cornea it is best to fit clear acrylic impression molded conformers. This allows the ocularist to check for any pressure points on the eye or displacement of the conformer during excursion to the four quadrants and obliques.)

As a side note, we have gone through the process of expanding the eyelid aperture in several more advanced microphthalmic globes where the final flush fitting molded clear acrylic conformer became final product. It gave enough magnification to serve as a 'cosmetic optics' scleral shell and did not require a hand painted iris cover shell prosthesis.

Tertiary Embryonic Stage (True Microphthalmos)

This young girl (with true microphthalmos) was 4 years old when first fitted with a scleral ocular prosthesis. (Note the typical hyperpalpebral fissure for this embryonic stage.)

Placement of a 'full thickness' scleral ocular prosthesis gave a near symmetrical alignment with the fellow sighted eye.

This same patient seventeen years later displays little characteristic change in the formation of the hyperpalpebral aperture when the prosthesis is removed.

The horizontal aperture will measure less to allow the prosthesis to move into the inner and outer canthus with lateral gaze.