Bilateral Anomalies
(Prominent Opaque Right Eye, Congenital Cataract Left)
 

When the blind convergent opaque eye is more prominent than the sighted globe the ocularist will attempt to color match the iris pigments while making the pupil size as close to that of the mydriatic aphakic sighted eye, (if it is not too erose).  This case proved to be initially quite a challenge, since the young patient had a tendency to always squint the sighted eye even when she wore her glasses.  The first before and after photos (Fig. 13A & B) bear this out, whereas, the following two photos (Fig. 13C & D) taken twenty four years later with same scleral cover shell prosthesis would indicate this was of short duration.

Figure 13A The evaluation prior to fitting a scleral cover shell prosthesis over the right eye showed a prominent opaque eye with a distorted cornea.

Figure 13B The completed prosthesis gave the appearance that it was the sighted globe and that the left eye was in need of a prosthesis.

Figure 13C A close up view of the affected right eye shows its prominence, turning in, and still has the distorted corneal bulge, while the left eye is no longer experiencing the squeezing of the orbicularis muscle.

Figure 13D All indications would show that the dysfunctional globe has not changed in size and shape since the prosthesis was first fitted 24 years earlier.  There may be a need to replace the prosthesis only because of the change in the iris pigments over the years.  (Note: The iris diameter is slightly larger to give a more balanced aperture, and becomes more cosmetically correct with a compensating minus power lens.)