Extreme Exophthalmic Globe
(Rx: Cosmetic Optics)
 

Attempts to diminish the appearance of an obtrusive dysfunctional eye without resorting to enucleation or evisceration had been to surgically narrow the aperture with sutures (canthoplasty).  This however, would cause further distortion of the eyelid aperture and on occasion cause pressure on the bulbous eye.  The following case presentation displays such an anomaly and how it was managed with a partially hand painted scleral prosthesis to first simulate catoptric (light reflex) image balance.  The exophthalmic globe with its cover shell prosthesis was then complemented with a minus power lens (cosmetic optics).

This patient did not want to have either surgical correction of the deviated supra-esotropic eye, or removal of the blind exophthalmic right globe even though it was causing an abnormally wide eyelid aperture.  Another existing cosmetic problem was that the eye had a dilated pupil with a pronounced cataract.

Figure 5A Frontal gaze demonstrates the wide palpebral aperture and deviated globe.

Figure 5B The anterior projection of the disfigured globe is quite apparent when viewed during its upward gaze.

Figure 5C The thin scleral cover shell prosthesis after being fitted with a catoptric imaged hand painted (over size diameter) iris will optically diminish the prominence of the eye when a properly prescribed minus power lens is worn.  The hand held minus 4 power lens has already shown improvement in facial balance.

Figure 5D The bulbous eye's cornea/iris was supra-esotropic, but the scleral color and vascular pattern were normal in appearance.  This visual impairment was whited out on the scleral cover shell and an iris was painted to align with the fellow eye allowing the balance of the prosthesis to remain in clear acrylic measuring less than one half of a millimeter.