Services for the Pediatric Patient

This page is designed to provide valuable information about pediatric ocular prosthetics. Joyce, our resident pediatric ocularist, bring over 40 years of professional experience in fabricating and fitting ocular prostheses for infants and children. As part of our collaborative team approach, Eric and Kurt contribute their expertise during the process, including taking preliminary impression moulds in our office or hospital outpatient facilities. They also specialize in replicating the iris color and scleral tint to ensure a natural result.

Some pediatric services we provide (but are not limited to) are:

Socket Impressions Under Anesthesia: Some pediatric patients are not as cooperative as we need them to be for us to obtain an accurate socket impression in our office setting. We work alongside the doctors at Boston Children's Hospital, Boston Medical Center and Mass Eye and Ear to schedule custom socket impressions while the child is under anesthesia.
Ocular Conformer Fittings: These are required for pediatric patients who were born with Congenital Anophthalmia and/or Congenital Microphthalmia. We fit the child with a series of ocular conformers, each one larger than the last, over a period of 3-6 months. The purpose is to expand the eyelid margin and create space within the socket prior to the fitting of the artificial eye.
Regular prosthetic size adjustments or prosthesis replacements due to growth and normal anatomical socket changes.

Please see below for our Frequently Asked Questions sections regarding Pediatric Patients.

Frequently Asked Questions: Pediatric Services

Why does my child need an ocular prosthesis after the loss of an eye?

There are four reasons to wear an ocular prosthesis: Comfort, Cosmesis, plus continued Bony Orbital Wall, and Eyelid development. The first two reasons are of immediate importance for parent and child. Comfort is gained with a properly fitted prosthesis, (by relieving the physical stress caused by eye volume loss, and drooping of the eyelid). Cosmesis is recaptured with a lifelike appearance that is once more acceptable to you, your child and peers. The other two reasons are directed toward your child's formative years. An adequate sized prosthesis is required to maintain near symmetrical bony orbital wall and eyelid development.

My child was born with a partially developed (microphthalmic) eye, is it possible to fit a cover shell prosthesis over such a globe?

Yes, a molded cover shell prosthesis can be fitted over any stage of microphthalmos. The early stage of microphthalmos may require a series of molded clear acrylic trial shells to gradually enlarge the palpebral fissure (eyelid margins) before a prosthesis can be fitted.

Will it be difficult for my child to be fitted with an artificial eye?

Yes and No. Each child is different in mood, personality, disposition and what they have gone through prior to this referral for an artificial eye. We can only determine this during the initial evaluation. As with all patients we want to take an impression molding of the cavity. This is not a painful procedure, but we do require the child to be relaxed (as possible) and not squeeze the eyelids. This impression will allow us to 'read' our duplicate copy of the socket and prepare a prosthetic model for trial fitting. If this is not possible, we would request an EUA (Examination Under Anesthesia) where your child would be anesthetized for less than 10 minutes. This is usually done on an out-patient basis at a local hospital: (Children's Hospital or Mass. Eye & Ear Infirmary). Your presence during an EUA is welcome.

What is the process of getting an ocular prosthesis for my child?

If this is a recent eye loss, you would be referred to an ocularist by your pediatric ophthalmologist, or primary care physician. Local, statewide and national healthcare insurers require this paper trail for approval of this service.

At what age should my child begin to wear an ocular prosthesis?

If this is a congenital anomaly, born without an eye(s) or a partially formed globe(s), there would be a preparatory stage of plastic conformers in incremental sizes (in order to expand the eyelid margin and create space within the socket) prior to the fitting of the artificial eye. This process can be anywhere from three months to three years, depending on the severity of the abnormal development of the bony orbital wall and the palpebral fissure aperture (eyelids).

If on the other hand, this is an acquired eye loss due to disease or trauma, we would begin the fitting of an ocular prosthesis in six to eight weeks post-operative.

How sensitive are the tissues under the eyelids when you put the prosthesis in?

The tissue sensitivity is similar to you putting a piece of hard candy into the mouth (between the teeth and cheek).

Is it difficult for my child to adapt to wearing the prosthesis?

It is amazing how quickly a young child can adjust to monocular vision and the wearing an artificial eye, as compared to the adult prosthetic eye wearer who is readjusting from a lifetime of having depth perception. It becomes a second nature to a child, and they are quite uninhibited. We have parent and teacher stories of children removing the prosthesis during 'show and tell' in school, or when complimented by strangers about how pretty their eyes are.

How do I help my child care for the prosthesis?

Printed hygiene care instructions will be given upon completion of the prosthesis, plus we will demonstrate the daily maintenance and periodic removal care. Also, instructions are available in our Prosthesis Hygiene & Care section.

How do I help my child to remove and reinsert the prosthesis?

At our laboratory, we will demonstrate removal and reinsertion upon completion of the prosthesis. We also have instructions available in our Prosthesis Removal & Reinsertion section.

Is there any cautionary advice you can give regarding the prosthesis and my child?

Yes, during your child's teething stage, we have had reports that he/she will remove the prosthesis and begin to bite on it (these small teeth marks can be polished off). However, we also have had a few reports of children swallowing it. (If this occurs, you will have a diaper check, prior to having it disposed of or sterilized.) To date, there has been only one report in fifty-plus years of a child choking on it where the Heimlich maneuver was applied!