Ocular Prostheses with Eyelid Attachment

An individual may not know the importance of the eyelids until a malignancy or severe trauma affects it in such a manner that even a partial loss of the eyelids can result in the loss (evisceration or enucleation) of a perfectly healthy eye.  The eyeball cannot function without normal tear flow to keep the cornea moist, while protecting it from harsh irritating fumes and dust particles.

Loss of Upper Eyelid

This first case presentation deals with the loss of the upper eyelid due to a malignancy.  An attempt was made to fit a clear flush fitting cover shell to prevent the cornea from ulcerating, but it was not successful.  An evisceration was performed with a small ball implanted within the scleral stump.  An impression moulded ocular prosthesis was fitted.  Once this was completed an acrylic upper eyelid was attached with the addition of eyelashes.  The end result proved to be very satisfactory because the rectus muscles still functioned which gave movement to the prosthesis.  In addition the lower eyelid was very flaccid (because of the patients age) and by squeezing the right facial muscles he was able to close the lower eyelid over the prosthesis to keep it moist.

Figure 26A The prosthetic with the acrylic upper lid fit snuggly under the eyebrow excellent retention.  The addition of the eyelid gave symmetrical balance and enhanced cosmesis.  The arcus senilis (ring of age) in the cornea also gave a three dimensional affect to the ocular prosthesis.

Figure 26B The eviscerated right eye was completely exposed to the elements and required an eye patch prior to being fitted with the cover shell prosthesis.

Figure 26C The depth under the eyebrow hid most of the upper portion of the artificial eyelid.

Partial Loss of Upper and Lower Eyelids

Concentrated radiation treatment for eyelid malignancies result in loss of the tear ducts, the eyelashes, and causes constriction and toughening of the remaining eyelid structure.  Treatment of the external tissues also resulted in loss of the sighted eye.

Figure 27A The post-operative result following enucleation of the right eye shows additional loss of adipose tissue in the superior sulcus.

Figure 27B The ocular prosthesis required an addition of several millimeters of eyelid structure in acrylic, including cilia (eyelashes).  The prosthesis was retained by the remaining shallow fornices.

Figure 27C A close up view of the prosthetic unit with its acrylic lids and eyelashes in position shows how it compliments the palpebral aperture.  But, it is unable to improve upon the enophthalmic deficiency within the superior sulcus, caused by the loss of adipose (fatty) tissue.  It is at this time when 'cosmetic optics' is called upon to make this area less conspicuous.

Figure 27D Cosmetic optics with thick framed tinted lenses serve as a detractor from the deep superior sulcus depression and from the immobile prosthesis.