Primary Embryonic Stage
(True Anophthalmos)

When the congenital anomaly is the absence of an eye and/or partially formed eyelids it is far more complex to manage, because the bony orbital wall and facial features never completely developed.  Our method of non-surgical augmentation of the orbital area and the eyelid aperture (with pressure stem conformers) is an accepted standard of treatment, and is practiced by other Board Certified Ocularists and members of the American Society of Ocularists.  Because of the number of laboratory fitting sessions and the length of time it takes before the first ocular prosthesis is fitted, it is recommended parents seek this service from an ocularist close to their home.

This first case presents bilateral narrow bony orbital walls with micro-eyelids that were slit-like, firm and taut, with entropion (inversion) of the lower eyelids and lashes.  When the eyelids are separated there is no eyeball present and the socket is funnel shaped lacking definition of culs-de-sac or fornices (internal eyelid formation).  This is the earliest of prenatal stage aberrations.  The cavity will neither retain nor self-support any type of prosthetic device without first applying (long-term) external force to the orbital void with empirically fitting a series of incremental sized and shaped pressure stem conformers.  The object its to gradually expand the eyelid aperture while trying to create fornices (the under part of the eyelid).  The projected time span before an ocular prosthesis can be retained is usually 1 to 3 years.

Figure 1A This display of five bilateral incrementally larger empirically fashioned pressure stem conformers indicates the upper series for the right socket began with a slightly larger cavity and retained that rate of expansion throughout the fitting process.

Figure 1B The first pair of conformers was fitted when the child was 3 months old.  In order to retain the stem conformers, tape was applied across the brow to the cheek.  This also prevented the child from rubbing them out of the cavities.  The conformers also remained in continuously, with exception for cleaning.

Figure 1C The first self-retained prosthetic models were trial fitted one year later, but the largest pressure stem conformers were still utilized at bedtime as a precaution not to lose any orbital space gained.  (Note the narrow fissure-left eye, with marked entropion of the lower lid.)