Ocular Prosthetics
Artificial Eyes

History of Artificial Eyes

History is unclear about where the craft of making artificial eyes began. Artificial eyes have been made of wood, porcelain, stone and gold found in Egyptian mummies. There is some evidence that Venetian glassmakers started crafting glass eyes, as we know them today.

In the 19^th century, German glass eye makers set up shop in the United States. They traveled throughout the country, setting up shop in a city for a number of days before moving on. 

Glass eyes have also been fit out of "stock." A patient may have sent away via mail order or a doctor may have kept drawers of artificial eye stock on hand. The best fit and color match was determined from hundreds of choices.

Plastic artificial eyes, as we know them today, began to be made in the United States during World War II. Because German glass eye makers were not coming into this country at that time, an alternative was needed. 

It is believed that, ironically, a German, Fritz Jardon, in conjunction with American Optical Company, worked with the Army and Navy to develop the acrylic ocular prosthetic. The acrylic, known as polymethylmethacrylate (PMMA), is used because of its outstanding optical qualities. It is the same material from which old "hard" contact lenses were made. It is durable and has a long life.

Plastic eyes have many advantages. The most important is the ability to impression fit the eye. Plastic eyes can be polished, removing any buildup or debris accumulated on the eye.

Many patients still refer to their artificial eye as a "glass" eye.  However, in truth, very few eyes today are made of glass. Most artificial eyes are PMMA. 

Artificial Eyes

Artificial eyes are used in a patient following enucleation surgery. In an enucleation, the eye is removed and an implant is put in its place, with tissue being closed over the implant. Fitting an artificial eye can begin approximately 6-8 weeks following surgery.

Step 1: To begin making a custom prosthesis, a mold of the eye socket is made. A tray is placed under the lids and a molding agent is injected into the tray. Once set, the mold is removed from the socket.

Step 2:  A wax shape is made to try in the socket. Wax is used because it can be easily changed and carved or added to quickly. The goal is lid symmetry.

Step 3:  Once the wax shape is completed, prosthesis fabrication begins. A stone mold is cast from the wax shape. The stone mold holds the plastic for the prosthesis during the curing process.

Step 4:  A "painting shell"(a prosthesis left with the clear cover unattached) is made. The prosthesis can be put together and tried on the patient. 

The color is evaluated. If the color needs to be enhanced, the clear cover is removed and the color touched up. All custom prosthetics are hand painted to achieve the best color match.

Step 5:  Once the color has been completed, a prosthesis left with the clear the prosthesis is then ready for delivery to the patient.

Scleral Shell

A scleral shell is used when a patient has had evisceration surgery or when a patient's globe remains in the socket.  In an evisceration, the contents of the eye are removed from the globe, an implant is placed within, and the wound is closed.

In cases where patients still have an eye in their socket, it is necessary to create a thin shell. The patient's eye may be phthisical, meaning it is small and soft, or microphthalmic, a small underdeveloped eye. It may also be disfigured from trauma or disease.

Step 1:  A mold of the eviscerated socket or globe is made.

Step 2:  A wax shape or clear custom conformer may be used to determine fit of the shell.

Step 3:  Once the shape is determined, a stone mold is made.

Step 4:  The shell is then custom-hand painted to match the fellow eye.

Step 5:  A clear cap is molded onto the front surface and cured. The entire prosthesis                        is polished to a high gloss and delivered to the patient.

Orbital Prosthetics 

An orbital prosthesis is used in the case of exenteration surgery. Exenteration is performed when a patient has a cancer, for example, even though not all cancers require exenteration surgery. In exenteration, all contents of the patient's eye socket are removed, to the bone of the orbit, in some cases. Skin grafting may then be used to close the wound.

Exenteration surgery can leave the patient without an eye, eyelid and, possibly, eyebrow.  The result, while lifesaving, can be emotionally devastating to the patient. This type of surgery is the most difficult for which to make a prosthesis. 

Step 1:  A mold of the orbit is made using a molding agent. Once set, a backing of stone is applied to give the mold stability.

Step 2:  A stone mold of the molding agent is made. This mold becomes the working model.

Step 3:  A base plate wax is used as a "holder" for the eye and clay is used to form the lids.

Step 4:  The eye is placed in the "shell" using clay.  The eye must be in the correct gaze, meaning it must look straight ahead. Because the prosthesis will not move with the fellow eye the placement of the prosthetic eye is crucial. 

Step 5:  Once correct gaze has been established, the lid can be carved. The goal is correct contour and fullness.

Step 6:  Primary color of the flesh tones is matched.

Step 7:  A mold is made in which to process the material.

Step 8:  Once the mold is complete, the artificial eye is cast in the "flesh" material.

Step 9:  The partially completed prosthesis is painted to match flesh tones; eye lashes and, if needed, eyebrows are placed.

Step 10:  The completed prosthesis is then ready for the patient.

Care of Your Prosthesis

Routine prosthesis care and maintenance is crucial to maintaining a healthy eye socket.  Prosthetics will accumulate a build-up of calcium and protein from your body's tear film.  This build-up needs to be polished away to maintain a healthy socket.

Today, artificial eyes are made of hard plastic. They are much more durable than glass eyes of many years ago.

To remove your prosthesis:

1. Wash hands thoroughly.
2. Apply suction holder to center of prosthesis.
3. Holding suction holder with one hand, pull down lower lid.
4. Slide prosthesis down and out from underneath upper lid.

To clean prosthesis:

1. Rinse prosthesis thoroughly with warm water.
2. Rub with a mild soap to clean away debris and hand oils
3. Rinse thoroughly.

To re-insert prosthesis:

1. Apply suction holder slightly below center of iris.
2. Lift upper lid and slide prosthesis up underneath.
3. When prosthesis has been pushed under upper lid, release upper lid and pull lower lid down.
4. Set prosthesis in place.
5. Squeeze suction holder to release from prosthesis.

Frequently Asked Questions about Caring for Your Prosthesis

Q. Can I sleep in my prosthesis?

A. Yes, you can sleep in your prosthesis. It is recommended that you leave your prosthesis in at all times.

Q. How often should I clean it?

A. Clean your prosthesis whenever it "feels dirty."  It may feel "gritty" or "gummy."  Each patient is unique. Most patients will develop their own cleaning schedule. The less a patient needs to handle his/her prosthesis, the better.

Q.  What is it made of?  Is it a "glass" eye?

A.  Eyes are very rarely made of "glass" today. They are made of an acrylic resin capable of being polished to a high luster. It can also be modified as needed.

Q. How often does it have to be replaced?

A. Each patient is unique. As our bodies constantly undergo change, so does the eye socket change. Your socket may lose some of its orbital fat and your implant may migrate. Many circumstances could cause the need for a new prosthesis. 

 If your prosthesis is years old and has had many polishings, the clear acrylic capping may be worn through and the artwork cut into. The plastic layers may delaminate, giving the appearance of a "cataract" on the pupil.

Most ocularists recommend frequent prosthesis check-ups. Every 6-12 months is the normal recommendation. The deterioration of your prosthesis will be gradual.  With frequent checks, your ocularist can advise you when a replacement may be necessary.

Q. Will my insurance cover my prosthesis?

A. Some insurance plans have prosthetic coverage. Check with your carrier to see if you have coverage.

Q. How do I remove my prosthesis to clean it?  How do I get it back in the socket?

A. See Caring for your Prosthesis.

"...thank you for the time and effort you put into the orbital prosthetic that you made for my friend. As your first attempt at such a challenge, may I say you did a marvelous job. Your kindness toward her, your respect for what she was going through and your determination were the perfect combination."
- from a letter sent by a patients friend.