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CASE REPORT
Year : 2013  |  Volume : 31  |  Issue : 3  |  Page : 194-196
 

Custom-made ocular prosthesis for a pediatric patient with unilateral anopthalmia: A case report


1 Department of Prosthodontics, RKDF Dental College, Bhopal, Madhya Pradesh, India
2 Department of Prosthodontics, People's College of Dental Sciences and Research Centre, Bhopal, Madhya Pradesh, India
3 Department of Prosthodontics, People's Dental Academy, Bhopal, Madhya Pradesh, India
4 Department of Pediatric and Preventive Dentistry, People's Dental Academy, Bhopal, Madhya Pradesh, India

Date of Web Publication11-Sep-2013

Correspondence Address:
Saurabh Shrivastava
Saurabh Nursing Home, 82, Marwari Road, Near Azad Market, Bhopal - 462 001, Madhya Pradesh
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0970-4388.117973

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   Abstract 

Congenitally missing eye, often called as anopthalmia, is a rare condition. This causes disfigurement of the face, which poses psychological effect on children, making them emotionally weak and conscious which, in turn, causes anxiety, stress, and depression at an early age in life. The custom-made ocular prostheses should thus be provided as soon as possible to help children improve their social acceptance. We present a case of 9-year-old boy who reported with congenital anopthalmia of right eye, which was then restored with custom-made ocular prosthesis.


Keywords: Anopthalmia, children, custom-made ocular prosthesis


How to cite this article:
Shrivastava S, Agarwal S, Shrivastava KJ, tyagi P. Custom-made ocular prosthesis for a pediatric patient with unilateral anopthalmia: A case report. J Indian Soc Pedod Prev Dent 2013;31:194-6

How to cite this URL:
Shrivastava S, Agarwal S, Shrivastava KJ, tyagi P. Custom-made ocular prosthesis for a pediatric patient with unilateral anopthalmia: A case report. J Indian Soc Pedod Prev Dent [serial online] 2013 [cited 2019 Jul 22];31:194-6. Available from: http://www.jisppd.com/text.asp?2013/31/3/194/117973



   Introduction Top


Anopthalmia is a condition in which no eyeball can be found in the orbit. There are several causes for missing eye, including congenital deformities, malignancy, infection, and cosmetic reasons. [1] The disfigurement associated with the loss of an eye can cause significant physical and emotional problems. [2]

The fabrication of a custom-made ocular prosthesis for a child is the same as for an adult, but periodic enlargement of the prosthesis is necessary to aid in the normal development of the lids and the soft tissue lining the orbital bone required for good cosmetic result. [3],[4]


   Case Report Top


A 9-year-old boy reported to the Department of Prosthodontics along with his mother with the complaint of facial disfigurement due to missing right eye. The eye was found to be missing since birth and had also caused lot of emotional insecurity and stress to the child by his schoolmates. After examination of the ocular defect, treatment plan was explained to the child by simple diagrams and posters to gain his cooperation. [5]


   Method Top


  1. A thorough examination of the ocular defect was done and resiliency of superior and inferior palpebrae was checked through inspection and palpation.
  2. A thin layer of petroleum jelly was applied on the eyelashes and around the anopthalmic socket to aid in the removal of impression.
  3. Impression of anopthalmic socket was made with polyvinyl siloxane impression material (Aquasil Ultra XLV; Dentsply DeTrey, Konstanz.Germany) [Figure 1].
    Figure 1: Impression made of anopthalmic socket

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  4. Cast was obtained and wax pattern was adapted on it. A prefabricated iris button from the stock eye was selected resembling with the patient's left eye (as per Laney and Gardner [6] ) and was placed on the wax pattern in the center of eye socket on master cast. The contours of the wax pattern along with the iris were then clinically modified to achieve maximum comfort and esthetics [Figure 2].
    Figure 2: Wax pattern trial

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  5. Flasking and dewaxing procedures were carried out in a usual manner, but the iris position was stabilized with the help of an acrylic rod before flasking [Figure 3]. Heat-polymerizing tooth-colored acrylic resin (Acralyn; Asian Acrylates, Mumbai, India) of appropriate shade matching with the left eye was used, and after doing a trial closure, characterization was done by adding stains and fibers to simulate veins to give a more natural appearance to the custom eye prosthesis [Figure 4].
    Figure 3: Iris position stabilization with acrylic rod

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    Figure 4: Final prosthesis

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  6. After final closure, processing was carried out by a long curing cycle. After complete curing, the prosthesis was finished, polished, and disinfected. It was then inserted in the patient's eye socket [pre- and post-operative views are given in [Figure 5] and [Figure 6], respectively.
    Figure 5: Pre-operative view

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    Figure 6: Post-operative view

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  7. The child and his parents were taught the method of removal and insertion of prosthesis. They were asked to let the child remove the prosthesis during night to give rest to the tissues and were also instructed regarding cleaning and maintenance of prosthesis. They were recalled six-monthly for regular checkup.

   Discussion Top


Ocular prosthesis can either be prefabricated (stock eye) or custom made. The close adaptation and characterization of the custom-made ocular prosthesis provides maximum comfort, esthetics, and also maintains its orientation when patient performs various movements, as compared to prefabricated prosthesis. [3],[7]

Treatment of congenital deformities should be done within the first 4 weeks of birth by placing a small ocular prosthesis (conformer) in the conjunctiva socket. To prevent the cul-de-sac from shrinking and to promote development, a conformer of a larger size must be changed as the child grows. [1]


   Conclusion Top


Rehabilitation of pediatric patients who have suffered the psychological trauma of an ocular loss requires a prosthesis that can provide optimum cosmetic and functional results as early in life as possible to help children improve their social acceptance. The custom-made ocular prosthesis is recommended as an effective alternative form of treatment.

 
   References Top

1.Valauri AJ, Mc Carthy JG. Maxillofacial prosthetics. In : Mc Carthy JG (Editor), Plastic Surgery, (vol. 5 Tumours of the head and neck & skin). 3 rd Ed. Philadelphia, Pa. saunders; 1990. pp. 3537-41.  Back to cited text no. 1
    
2.Lubkin V, Sloan S. Enucleation and psychic trauma. Adv Ophthalmic Plast Reconstr Surg 1990;8:259-62.  Back to cited text no. 2
    
3.Cain JR. Custom Ocular Prosthesis. J Prosthet Dent 1982;48:690-4.  Back to cited text no. 3
    
4.Beumer J, Curtis TA, Marunick MT. Maxillofacial Rehabilitation- Prosthodontic and Surgical considerations. Beumer J, Curtis TA, Marunick MT (Eds), Ishiyaku EuroAmerica, Inc, St. Louis; 1996. pp.417-31.  Back to cited text no. 4
    
5.Wright GZ, Starkey PE, Gardner DE. Factors influencing the use of behavioural management techniques during child management by dentists. Child Manage Dent, 1987. pp. 86-97.  Back to cited text no. 5
    
6.Laney WR. Custom made ocular prosthesis. Maxillofacial Prosthetics 2006; pp. 279-306.  Back to cited text no. 6
    
7.Doshi PJ, Aruna B. Prosthetic management of patient with ocular defect. J Indian Prosthodont Soc 2005;5:37-8.  Back to cited text no. 7
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    Figures

  [Figure 1], [Figure 2], [Figure 3], [Figure 4], [Figure 5], [Figure 6]


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    Abstract
   Introduction
   Case Report
   Method
   Discussion
   Conclusion
    References
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