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The Ocular Impression: A Review of the Literature and Presentation of an Alternate Technique
Mark F. Mathews, Rick M. Smith, Alan J. Sutton and Ron Hudson Journal of prosthodontics 2000;9:210-216

Introduction Anatomy History The ocular impression: review of literature An alternative technique

Removal and replacement

Post insertion care Discussion References 3

Introduction

Introduction

Maxillofacial prosthetics is the art and science of anatomic, functional, or cosmetic

reconstruction by means of non-living substitutes of those regions in the maxilla,

mandible, and face that are missing or defective because of surgical intervention, trauma, pathology or developmental or congenital malformation.

The branch of prosthodontics concerned with the restoration and/or replacement of the stomatognathic and craniofacial structures with prostheses that may or may not be removed on a regular or elective basis.
-GPT8

Ocular prosthesis have been used for centuries to provide a cosmetic replacement for enucleated or eviscerated eyes.

Goal of prosthetic treatment - Return the patient to society

with a normal appearance.

Anatomy

Orbit
Contents of orbit

1. Eyeball 2. Fascia: Orbital and bulbar. 3. Muscles: Extra ocular muscles 4. Vessels: Ophthalmic artery, superior and inferior ophthalmic Veins and lymphatic's. 5. Nerves: Optic, occulomotor, trochlear, abducent, branches of ophthalmic nerve and sympathetic nerves. 6. Lacrimal gland 7. Orbital fat.
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EXTRAOCULAR MUSCLES
Voluntary muscles 1. Four recti: (a) Superior rectus (b) Inferior rectus (c) Medial rectus (d) Lateral rectus. 2. Two obliqui: (a) Superior oblique and (b) Inferior oblique 3. Levator palpebrae superioris
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IRIS ANATOMY

Pupil

Medial canthus

Limbus

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CAUSE FOR LOSS OF EYE

congenital defect

irreparable trauma

tumor

a painful blind eye

sympathetic ophthalmia

excision for histological confirmation of a suspected diagnosis

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SURGICAL MANAGEMENT
3 approaches :

evisceration- surgical procedure wherein the intraocular contents of the globe are removed, leaving the sclera, Tenon's capsule, conjunctiva, extraocular muscles, and optic nerve undisturbed; the cornea may be retained or excised.

enucleation-is the surgical removal of the globe and a portion of the optic nerve from the orbit.

exenteration- is the en bloc removal of the entire orbit, usually involving partial or total removal of the eyelids, and is performed primarily for eradication of malignant orbital tumor

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SURGICAL REHABILITATION IS LIMITED BY :

Availability of tissue
Tissue contractures Physical condition of patient Very large defect Compromised vascular supply to radiated tissue

bed
Advanced age of patient
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History
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Dating from very early times in Egypt (i.e., the predynastic Period, before 3000 B.C.), simple inlaid eyes, consisting usually of white shell beads, have been found, and human figures bearing such eyes are to be seen in the Cairo museum.

Ambroise Pare (1510-1590), a Frenchman, was the first to use both glass and porcelain eyes. By 1835 artificial glass eyes were being produced on a large sale in Germany, which continued as the center of production.
International Ophthalmology Clinics: Winter 1970 - Volume 10 - Issue 4 - ppg 713-719
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During the two world wars, the supply of glass eyes from Germany to

the United States was halted, and in 1943 the United States Army and
Navy both undertook research to find a substitute. Attention was concentrated on plastics, and the development of an acrylic eye resulted. By 1945, the Army thousands of artificial plastic eyes were being

produced.

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The Ocular Impression: A Review of the Literature and Presentation of an Alternate Technique

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Direct impression/external impression Impression with a stock ocular tray or modified stock ocular tray Impression with custom ocular tray Impression using a stock ocular prosthesis Ocular prosthesis modification, The wax scleral blank technique.

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1.The Direct Impression/External Impression

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2. Impression With Stock Ocular Tray

.

Most common impression technique To help support the impression material. Also called as modified impression method. Perforations present in tray.

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3.Stock Ocular Tray Modifications

Variations of the modified impression method
Maloney - 3 channels were placed through the superior edge of set of customized stock trays to prevent air entrapment. A raised ring around the stem prevents the eyelid
.

from blocking the channels.

Engelmeier -Casting a set of stock trays in

Ticonium to permit sterilization and reuse.

Sykes, Essop, and Veres - Use of modeling plastic

impression compound as an ocular tray

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4.Impression With Custom Ocular Tray

.

Miller -A custom ocular tray is necessary in certain situations.

The anophthalmic socket could be highly irregular or stock trays may not be available. Millers method involves attaching a solid suction rod to the patients existing prosthesis, conformer, or wax shell and investing it in an alginate mold . After the alginate sets, the prosthesis, conformer, or wax is removed and replaced with clear acrylic resin. Perforations are made in the resulting tray, and a tunnel is cut into the stem through which impression material can be delivered. An impression is made using injected alginate.

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5.Impression Using Stock Ocular Prosthesis

.

Use of a stock ocular prosthesis as a tray to carry impression material.

Select an esthetic stock eye and reduce peripheral and posterior aspects. Lined with a thin mix of ophthalmic alginate and inserted for the definitive impression.

The resulting impression is processed, providing a customized stock prosthesis.

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6.Ocular Prosthesis Modification

.

Modification of an existing prosthesis to gain acceptable fit. Trimming and polishing a stock prosthesis will sometimes achieve this goal. Alternately, the stock prosthesis can be modified using alginate or soft wax, and then invested and processed.

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Smith -Reline procedure for an existing prosthesis using a dental impression wax.
.

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Ow and Amrith- Use of a tissue conditioner as a reline material because of its biocompatibility and ease of manipulation.
.

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Wax Scleral Blank Technique

Benson-Created a wax blank by adapting base plate wax around half of an appropriately sized steel ball. The resultant pattern is smoothed, tried in, and adjusted. After the addition of an iris button, the pattern is invested and processed.

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Method of attaching the iris disk

Ref-Journal of Prosthodontics (2008) 223227

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Moore, Ostrowski, and King-an esthetic Iowa implant conformer for use during healing.

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An alternative technique

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Disinfect and lightly lubricate the patients existing prosthesis or conformer.

Fill a medicine cup with quick set stone

and invest the tissue side of the prosthesis to the height of contour.

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When set, notch the edges of the stone cast. Mix a small amount of PVS

putty and adapt it over the top of the prosthesis and into the notched
indices. Remove the putty cope, and cut a large, beveled sprue hole into its

center and a small vent to the side.

Remove the prosthesis from the mold , lubricate the stone surface and replace the putty cope.

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Mix chemical-cure polymethylmethacrylate and pour it into the mold. Place the assembly in a pressure pot for 20 minutes at 25 psi.

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Remove the acrylic resin tray, trim and thin as needed. Perforate the approximate pupil location with a 3- 4mm diameter hole. Place multiple perforations over the remainder of the surface.

Smooth and polish the custom tray .

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To fabricate the injection tube, unscrew the tip of a 5-mL plastic syringe, and cut approximately 7 mm from the end.

Roughen the sides of the tip and wedge it into the pupil perforation hole. Secure it with cyanoacrylate resin.

Repolish the tray, and check for rough

spots.
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Clean and disinfect the custom tray. Try in the tray and check for overextension and proper orientation.

Attach the barrel of the 5-mL syringe to the injection tube.

Orient the tube with the numbers facing upward.

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Mix 3 teaspoons water to 1 tablespoon ophthalmic alginate impression material , and back load the syringe.

Insert the plunger, seat the tray, and inject the alginate.
After the alginate impression material has set, remove and check the impression for acceptability.

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A wax trial ocular prosthesis (blank) can be made chairside by using

the double alginate technique.

Suspend the impression in a small cup using a clothespin.

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Pour a new mix of irreversible hydrocolloid into the cup, surrounding

the impression.
When set, remove the alginate mold with impression from the cup.

Partially section the alginate mold, spread it, and retrieve the original
impression.

The different mixes of alginate will not adhere to each other.

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The second alginate impression becomes a mold to form the wax blank. Replace the alginate mold in the cup, and pour ivory wax through the

sprue hole created by the syringe tip.

Upon cooling, remove the impression from the cup to retrieve the wax blank.

Cut off the sprue, and shape and polish the wax trial ocular prosthesis.

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Try in the wax trial prosthesis. Assess fit, contour, and comfort.

Add the iris button to the pattern, then process.

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Post insertion care

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1. 2. 3. 4. 5.

Adjusting to the prosthesis . Period of wear . Placed in water or contact lens soaking solution. Never be allowed to dry otherwise it causes various layers to separate. Maintain normal facial animation and to avoid habits designed to hide the prosthesis.

6. 7. 8.

Eye lubricants. Polishing. No contact with alcohol,spirits

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Removal & replacement

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The prosthesis sometimes may get dislodged , so the patient must be able to replace in its position to avoid any embarrassment.

Hence it is essential that each patient be trained in the method of removal and the replacement of the prosthesis before the patient leaves the dental office.

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Patient is asked to tilt the chin downward looking at mirror. Forefinger used to pull the lower lid and at the same time pushing prosthesis gently backward and toward the nose. This will disengage the lower edge of the prosthesis and it is removed out. If it is not removed out with the above said procedure, rubber suction cup may be used .
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Patient must clean and dry his hand. Looking in the mirror with chin down
Top edge of the prosthesis engaged under the upper eye lid, forefinger of the other hand is used to elevate the upper lid.

The prosthesis should be gently pushed upward and back ward.

While the upper lid is released the lower lid is pulled downward Gentle pressure will cause prosthesis rotate backward and inward behind the lower lid to seat the prosthesis.
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Discussion

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CUSTOM OCULAR PROSTHESIS

Advantages Disadvantages

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A good impression

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References
1. Bartlett SO, Moore DJ: Ocular prosthesis: A physiologic system. J Prosthet Dent 1973;29:450459
2. International Ophthalmology Clinics: Winter 1970 - Volume 10 - Issue 4 - ppg 713-719

3. Schneider RL: Modified ocular prosthesis impression technique.J Prosthet Dent 1986;55:482485
4. Taicher S, Steinberg HM, Tubiana I, et al: Modified stockeye ocular prosthesis. J Prosthet Dent 1985;54:95-98 5. Brown KE: Fabrication of an ocular prosthesis. J Prosthet Dent 1970;24:225-235 6. Dorrey J. Moore,John S. Ostrowski, and Lawrence M. King;A quasi-integrated custom ocular prosthesis jpd oct 1974

7. Sykes LM: Custom made ocular prostheses: A clinical report. J Prosthet Dent 1996;75:1-3
8. Ocular prosthetics: Use of a tissue conditioner material to modify a stock ocular prosthesis R. K. Ow ,and S. Amrith-218 222
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Prosthodontist cannot replace this aspect, but can Restore the most beautiful aspect next to god.

Vision is the main aspect of the eye

Thank you!

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