Exophthalmic Globe with Hypersensitive Cornea
(Rx: Conjunctival Flap)
 

This young boy was born with an oversized globe with a sensitive cornea that could not tolerate a cover shell.  The parents did not want him to lose the eye even though it was blind and unsightly, but still wanted him to have an improved appearance.  A conjunctival flap was performed to cover the cornea, thereby desensitizing it.  The next step was to fit a very thin scleral cover shell type prosthesis with a slightly larger iris diameter to give the illusion of palpebral fissure symmetry even without cosmetic optics.  (Presented before the ASO: Lecture #774 'Ocular Prosthetic Problem Solving')

Figures 6A & 6B The exophthalmic right eye with a corneal conjunctival flap also shows inflammation of the conjunctival tissues following the flap procedure.  This shows frontal and upward gaze.

Figures 6C & 6D The exophthalmic right eye with the flush fitting scleral prosthesis matches the normal scleral white, tints and vascular pattern with an oversize iris to also give balance to the eye aperture.  The irregular conjunctival flap surface aids in producing responsive motility to the overlying flush fitting scleral cover shell prosthesis.

Figures 6E & 6F Note how the flush fitting scleral shell is synchronized with lateral excursion of the fellow eye.  To make the cover shell prosthesis less detectable the peripheral edges in the horizontal plane are 'feathered' from the scleral white to clear acrylic to blend in with the underlying conjunctiva in the canthi.