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
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).
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.
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.
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.