Recurrent Orbital and Eyelid Changes

It is interesting to follow patients over a long term (when possible) and have a photo record of the anatomical changes that occur.  This case in particular spans over a 20 year period.  The initial prosthesis was fitted shortly after the eye was surgically removed and during the first 16 years required three adjustments due to gradual loss or displacement of adipose tissue in the superior sulcus, plus some laxity of the orbicularis and levator muscles.  A second prosthesis was fitted and within another four years there was sufficient internal (orbital) and external (eyelid) changes to warrant a third prosthesis.  Visual comparison of the upper eyelids make it quite apparent that an adjustment or replacement prosthesis is required, however, an impression of the cavity and making a plaster copy of the socket can best evaluate the orbital changes responsible for these external anatomical imbalances.

Figure 18A This 16 year old prosthesis (being worn) reflects the internal and external changes that have occurred.  Note the marked superior sulcus depression, the loss of the upper tarsal lid fold, blepharoptosis and the hypopalpebral fissure (the entire left eyelid fissure is setting lower).

Figure 18B This prosthesis after 4 years began to display moderate superior sulcus depression, a barely defined tarsal lid fold and a recurrent upper lid ptosis.  The hypopalpebral eyelid however had been improved upon be extending the prosthetic shape into the inner and outer canthus.

Figure 18C The third prosthesis restored near symmetrical alignment of the eyelid structures.  Please note that in all prosthetic fittings the anterior projection of the prostheses never protrudes beyond that of the fellow eye.

Figure 18D The temporal profile view of each prosthesis shows how the curvature of the anterior surface was dramatically altered to in order to control the aperture and position of the eyelids.  The first two prostheses on shown on the left have past adjustments (in clear acrylic).  The newer prosthesis (right) with its superior peripheral extension gave deeper penetration into the upper sulcus.