When to refer to an Ocularist

WHEN TO REFER TO AN OCULARIST


Patients who need to be referred to an Ocularist 

usually fall into the following categories: 

1) recent Enucleation/evisceration, 

2) problems with an existing prosthesis, 

3) blind eyes requiring a custom scleral shell,

4) congenital anophthalmia/microphthalmia. 


POST OPERATIVE PATIENTS


Normally, patients who have had an Enucleation or Evisceration

should be referred to the Ocularist for fitting of the ocular 

prosthesis 6 to 8 weeks post operatively. This period of time 

allows for sufficient healing and a stable socket. 

Although patients healing rates vary by the technique and 

implant material used, age, previous treatments and other 

medical conditions, the anophthalmic socket or eviscerated 

globe is ready for fitting when chemosis and orbital inflammation 

have fully resolved. The impression fitting will be invalid

if significant change in the orbit occurs after the impression

is taken.

As an efficient interim measure, the patient can be referred 

at around 4 weeks following surgery for evaluation of 

the fit of the post operative conformer, to either 

fit a better fitting conformer, or fit a temporary prosthetic eye. 

This also allows the patient to be introduced to the Ocularist 

and the fitting and fabrication procedures.


PATIENTS WITH ESTABLISHED PROSTHESES


Patients with existing ocular prostheses will often 

need to be referred to the Ocularist for problems 

with either the surface condition of the prosthesis 

or problems with the fit of the prosthetic eye or scleral shell.

SURFACE CONDITION PROBLEMS


With continuous wear of an ocular prosthesis, 

there is a build up of a protein film on the surface 

of the prosthesis. This is normally cleaned off by 

the patient during a 1 to 3 month interval. 

This time span varies with each individual and can 

even vary throughout the year for the individual patient. 

With overextended wear, the protein build up can be quite 

encrusted and difficult to clean. The Ocularist often 

needs to polish off the stubborn surface deposits.

With normal wear and handling of the ocular prosthesis, 

it is not uncommon to acquire fine, 

hairline scratches in the plastic surface of the prosthesis. 

The scratches and other surface defects can be caused 

by many factors and need to be professionally polished out 

by the Ocularist.



POOR FIT OF THE OCULAR PROSTHESIS/SCLERAL SHELL

The fit of a prosthetic eye or scleral shell will 

deteriorate over time. The average life of an ocular 

prosthesis is 5 years. The most common reasons 

for prosthetic eye replacement is poor fit due to 

orbital fat atrophy and implant migration resulting 

in recession of the prosthesis with the corresponding 

narrowing of the palpebral fissure. In addition, 

the comfort of the prosthesis is often affected. 

With a scleral shell, continued phthisis or other 

changes in the globe may be contributing factors.

Children will often need more frequent replacements 

and/or enlargements to compensate for growth and 

help stimulate bony orbital growth.

Conditions of socket contracture, lagophthalmos, ptosis,

lower lid laxity, entropion, ectropion, implant exposure 

and other conditions can often be improved or minimized 

with the appropriate prosthetic modifications. 

In some cases, enlargement or reduction of the prosthesis

 is indicated and in other cases, replacement is the 

appropriate choice.


BLIND EYES REQUIRING SCLERAL SHELLS


Scleral cover shells are fitted over the conditions of phthisis bulbi, 

evisceration, congenital microphthalmia, 

and the normal sized, blind, disfigured eye. 

Scleral shells differ from prosthetic eyes in their thickness 

and length of wearing time depending on the size and 

sensitivity of the eye. 

If there are questions of successful wear of the scleral shell 

due to corneal sensitivity, they can be answered with a 

consultation with the Ocularist and may involve 

fitting of a clear trial shell.

CONGENITAL ANOPHTHALMIA/MICROPHTHALMIA

In cases of congenital microphthalmia and more importantly, 

congenital anophthalmia, 

it is important to refer the infant/child to the Ocularist 

as early as possible to start the fitting of conformers 

and/or prostheses to help stimulate bony orbital growth. 

Fitting of a series of increasing larger prostheses will help 

to minimize the hypoplasia and form an adequate socket. 

Normally, the only limiting factor is the stenotic palpebral fissure, 

but with time and non-surgical prosthetic augmentation, 

a good result is achieved. 

EUAs for impressions and/or fittings of larger shapes 

may be needed

SERVICES PROVIDED BY THE OCULARIST


The following summary will be of help in assessing 

the appropriate service to be requested 

by the ophthalmologist of the Ocularist.


CLEANING: as needed (1-2 month average) normally done by patient.

Monthly recommended.

In case of custom sclera shell most of the times daily removal during sleep

time is reocomended.


POLISHING: 1-2 minimum times a year depending on patient care.

                   In some cases a more frequent scheduling is needed.


ENLARGEMENT: within first 1-2 years of life of prosthesis or 

due to growth and or changes that occur in the ophthalmic socket..

REDUCTION: as indicated due to socket contracture, lagophthalmos, etc.

REPLACEMENT: Less than 5 years or as needed when change in fit,

comfort, cosmesis. Due to the requirements of most insurance policies, 

a written prescription from the referring physician 

or other appropriate eye care specialist is often required.

This content is reviewed periodically and is subject to change as new health 

information becomes available. 

The information is intended to inform and educate and 

is not a replacement for medical evaluation, advice, diagnosis 

or treatment by a healthcare professional


© Sankey International 2016