Prosthetic Eye: What You Need to Know

Pros

• A custom-made prosthetic eye can so accurately resemble a companion eye that it can be difficult for others to tell it’s artificial. 
• Changes in the eye socket are to be expected with the loss of an eye, but “a skilled ocularist can often build up the ocular prosthesis in such a way that the eyelid sits in a more normal, symmetrical position,” says Dr. Campbell Waldrop, an ophthalmologist in Fresno, California, in a RealSelf Q&A. 

Cons

• It takes a while to adjust to an artificial eye. Over time, the prosthesis should become more comfortable and eventually go unnoticed, but a prosthetic eye can become uncomfortable due to scratches or dullness on its surface, which can irritate the underside of the eyelids when blinking. You’ll need to go in for occasional polishing, to prevent potential problems.
• People with an artificial eye sometimes require additional surgery because the soft tissue of the eyelids and sockets can change over several years.
• To safeguard your remaining eye, your doctor will likely recommend that you wear protective glasses at all times after surgery.

“Stock” or “ready-made” ocular prostheses are mass-produced. Since a stock eye is not made for any particular person, it has no uniqueness in fit or color to a patient’s socket or companion eye. 

Stock prostheses are less expensive and readily available, but “many disadvantages exist in a stock ocular prosthesis,” according to researchers in a 2012 case report. For instance, a shape that doesn’t properly fit the space around the eye or the socket can lead to problems like pain, swelling, excess discharge, turning in of the eyelashes (entropion), and tissue scarring that can cause long-term deformity. 

The researchers also note that a custom-made prosthesis increases the adaptiveness and movement of the eyeball and exactly matches the iris position of the adjacent natural eye. So, they summarized, “to improve the comfort and matching of the prosthesis with that of the adjacent natural eye, a custom-made ocular prosthesis is preferred.”

There are two types of surgery to remove an eye.

• An evisceration removes the contents of the eye and the cornea (the clear, dome-shaped outer layer of the eye) while the sclera, the white of the eye, remains connected to the eye muscles.
• An enucleation removes the entire eyeball from the socket. The muscles that control eye movement are left intact and attached to the artificial eyeball. 

The American Academy of Ophthalmology says that both procedures generally result in the same appearance. Your surgeon will decide which surgery is right for you.

At the time of enucleation or evisceration, an implant is placed within the orbit or within the remaining scleral shell, to replace the missing socket volume. 

In an evisceration, the implant is wrapped by the sclera, with the extraocular muscles still attached. 

In an enucleation, the extraocular muscles are detached from the sclera and then attached to the implant. The tissues surrounding the eye—the tenon’s capsule and conjunctiva—are then closed over the implant.  

There are two types of implants: a solid, marble-like ball or an “integrated” implant made of porous material. The tissue from your orbit will grow into the small holes of the material, in effect making the implant part of your body. The benefit of this implant is that it prevents slippage within the socket. This implant can also be “pegged,” or connected to the back of the overlying prosthesis, to allow even more natural movement of the eye. 

Initially, a temporary prosthetic conformer, made of clear plastic, is put in place over the orbital implant. This conformer aids in healing and protects and maintains the tissue space behind the eyelids where the prosthetic eye will eventually sit. It’s important to keep the pocket well-formed, since it supports the prosthetic eye. 

When the socket has healed, it will look like a pink pocket behind the eyelid. 

It usually takes six to eight weeks of healing before you can be fitted for your custom prosthetic by your ocularist. They will take a mold of the socket (a short and painless procedure), then—after adjusting for proper fit, curvature, and gaze alignment—cast a custom prosthetic eye to fit over the implant. 

You’ll sit with the ocularist as they paint the iris to match your other eye. The white of the eye will be painted using the proper scleral tones, and red paint or silk threads will simulate the vein pattern in the remaining eye. 

It can take two or three visits for the custom prosthesis to be completed. Once it’s done, it will replace the conformer in the eye socket. 

RealSelf Tip: It takes time to adjust to using one eye—adults who lose sight in one eye find it harder to accurately judge distances, perceive depth, and track moving objects. Most people learn to compensate during the first year after surgery.