The Operation

Introduction

When an eyeball is diseased or damaged, the situation may arise where an operation is required to prepare for the fitting of an artificial eye. An Ophthalmologist is involved in assessing the need for an operation, which is only undertaken as a last resort.

An artificial eye is shell shaped. It is designed to sit over a ball-shaped orbital implant that takes the place of the eyeball, and is supported in place by the eye lids.

Left: artificial eye not fitted.  Right - artificial eye fitted.

Left: artificial eye not fitted. Right - artificial eye fitted.

The operation described below is the most frequent operation required to prepare for the fitting of an artificial eye.

Before The Operation

It is advised that you should avoid alcohol before (and after) the operation as there are anaesthetics and antibiotics involved.

Eye Removal

The first step in the surgery is the preparation of the eye socket.

  • Enucleation – the most common preparation is enucleation (removal) of the damaged or diseased eyeball.
  • Evisceration – less frequently, the sclera of the eyeball (the leathery outer casing) is retained.

A Haptic Lens is an eye prosthesis worn over a damaged or diseased eye – eye removal is not required prior to fitting of a Haptic Lens.

Orbital Implant

The second step in the surgery is the fitting of a spherical orbital implant.

There are various types of orbital implants. They can be made from acrylic, coral or synthetic coral type materials.

The final artificial eye will fit over this orbital implant and under the eye lids.

The muscles are attached to the orbital implant so the muscles of the eye can move the orbital implant (and therefore the artificial eye).

The eye muscles attach to the orbital implant

The eye muscles attach to the orbital implant

The muscle attachment means that when you make small eye movements (for example, during conversation) your artificial eye will follow the movement. For more extreme eye movements, there may be a lag.

Conjunctiva

The third step in the surgery is to bring the conjunctiva across the front of the orbital implant and suture (stitch) it in place.

The conjunctiva is the tissue you find on the inside of the eyelid.

The conjunctiva is sutured to enclose the orbital implant.

The conjunctiva is sutured to enclose the orbital implant.

There is now a space inside the eyelid where the artificial eye will be fitted.

Conformer Shell

The fourth step in the surgery is the fitting of the conformer shell.

As the final artificial eye is not available at the time of surgery, a clear plastic conformer shell is fitted to hold the shape of the eye socket and allow the eye lids to blink over the shell without rubbing the suture line.

The conformer shell holds the shape ready for the artificial eye.

The conformer shell holds the shape ready for the artificial eye.

The conformer shell will be worn for six to eight weeks after surgery.

Some ocularists will make a temporary artificial eye which can be worn as the conformer shell.

Note: The conformer shell may fall out due to the swelling in the eye socket. If this happens don’t panic.

Conformer shells can fall out - not a cause for panic

Conformer shells can fall out.

There is no urgency to return the conformer shell. You should return to the eye clinic and have it reinserted within a couple of days. The eye socket is more comfortable with the conformer shell in place.

Going Home

The Ocularists Association of Australia has prepared a brochure called Going home after Eye Surgery.

Essentially the message is to give yourself the chance to heal.

After the operation you should avoid heavy lifting. Walking and light cardio work is recommended.

We were once asked by a seventy year old lady if it is ok to do headstands two weeks after the operation. While we were impressed that she could still do a headstand we advised her to give it a few more weeks.

It is best to keep your head elevated to avoid pressure. This means using an extra pillow and generally taking it easy.

A Few Final Notes about Artificial Eyes

Thanks to Hollywood movies, specifically “Pirates of the Caribbean”, it is widely believed that a prosthetic eye is spherical. The orbital implant that is surgically fitted is spherical, but it can not be removed. The artificial eye that is removable has a thin shell shape – see illustration.

It is a quirk of monocular vision that you can not see the full movement of your artificial eye in a mirror. To get a true appreciation of the movement of your artificial eye you should video record the eye while you look left, right, up and down.

Things to remember before, during and after the operation

Mind Map Segment: The Operation

Mind Map Segment: The Operation

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