Primary dermis-fat implantation can be effectively performed in cases without pre-existing systemic vascular disease or orbital burns. Meticulous handling of the graft (using a Goeller trephine and Tenon's capsule tracti...Primary dermis-fat implantation can be effectively performed in cases without pre-existing systemic vascular disease or orbital burns. Meticulous handling of the graft (using a Goeller trephine and Tenon's capsule traction sutures), filleting Tenon's capsule, and avoiding cautery of the graft bed may minimize graft necrosis and atrophy. Pyogenic granulomas of the conjunctival-graft interface and graft hirsutism are easily managed. Keratinization of the socket, graft wound dehiscence, donor site hematomas, and wound dehiscence are avoided with careful surgical technique. Secondary dermis-fat orbital implantation may add orbital volume and conserve the conjunctival fornices, but may also suffer a slightly increased frequency and amount of graft absorption.
A variety of autogenous materials may be used for orbital implantation in the anophthalmic socket. An understanding of the pathology of the socket is necessary to treat the problem correctly. Autogenous grafts have been...A variety of autogenous materials may be used for orbital implantation in the anophthalmic socket. An understanding of the pathology of the socket is necessary to treat the problem correctly. Autogenous grafts have been used successfully to treat the superior sulcus deformity, extruding implant, and the contracting socket. The major advantages of autogenous material are its minimal inflammatory reaction and its total compatibility with the host.
The goal of the ocular prosthetic procedure is to return the patient to a normal appearance and lifestyle. Modern eye prostheses can give the patient an excellent physical and cosmetic result. In the final analysis, the...The goal of the ocular prosthetic procedure is to return the patient to a normal appearance and lifestyle. Modern eye prostheses can give the patient an excellent physical and cosmetic result. In the final analysis, the success or failure of the long-term use of the prosthesis is dependent on the cooperation of the patient in the care of his ocular prosthesis. It is important for the patient to be aware of and proficient in the care of his prosthesis. Patient education and professional follow-up will ensure the best prosthetic fit, appearance, and health of the anophthalmic socket.
An ocular prosthesis fitted over phthisis bulbi or a discolored blind eye of near normal size is a positive approach to improve the cosmetic appearance and psychological well-being of the patient. Unless surgical interve...An ocular prosthesis fitted over phthisis bulbi or a discolored blind eye of near normal size is a positive approach to improve the cosmetic appearance and psychological well-being of the patient. Unless surgical intervention is essential, fitting a prosthesis over the residual eye is a successful alternative to enucleation or evisceration. In general, for these individuals there is minimal disruption of the periocular tissues, thus, reducing fitting problems associated with enucleation and evisceration. A prosthesis properly fitted over phthisis bulbi or a discolored blind eye will maintain the integrity of the orbital anatomy, enhance cosmesis, and accelerate the rehabilitation of the patient.
In attempting to achieve acceptable cosmesis while maintaining comfort for the anophthalmic patient, communication between the ocularist and oculoplastic surgeon is of paramount importance. The ocularist must realize his...In attempting to achieve acceptable cosmesis while maintaining comfort for the anophthalmic patient, communication between the ocularist and oculoplastic surgeon is of paramount importance. The ocularist must realize his limitations in correcting deformities prosthetically and must communicate these limitations to the ophthalmologist when surgical alternatives are being considered.
Using an impression of the anophthalmic socket to facilitate the design of an artificial eye is common practice today. The Modified Impression technique was described in the American Journal of Ophthalmology, February 19...Using an impression of the anophthalmic socket to facilitate the design of an artificial eye is common practice today. The Modified Impression technique was described in the American Journal of Ophthalmology, February 1969, by Lee Allen and Howard E. Webster. It is a highly successful method that involves taking an impression of the socket using an impression tray, then making a wax casting of the impression, and final modifications to the anterior aspect of the wax model. A different technique has been in use in our office and elsewhere for more than 15 years, also with a high degree of success. We've dubbed it the "Empirical/Impression" method. It involves similar steps to the Modified Impression system, but in different order: first a wax model of the anterior aspect of the eye is designed and modified; second, an impression is made of the socket, using this wax model as an impression tray. The primary advantage of this method is efficiency. It involves one less laboratory procedure, hence making a "one-day custom eye" a reality. Although this process can be used in almost any case, the Modified Impression technique may work better for certain highly irregular sockets where "reading" the fornices by empirical means may be difficult. Either method requires a highly skilled and experienced fitter to make appropriate modifications to the anterior aspect of the prosthesis.
This article traces the history of facial and ocular prosthetics. Creative individuals who have made significant contributions are highlighted and the evolution of techniques and materials is presented. In view of the si...This article traces the history of facial and ocular prosthetics. Creative individuals who have made significant contributions are highlighted and the evolution of techniques and materials is presented. In view of the significance placed upon facial beauty in today's society, it becomes incumbent upon us to recognize the ingenuity and skill of those in the past to gain appreciation for the present state of the art and to provide incentive for improving facial and ocular prosthetic restorations in the future.
Careful surgical technique is important in enucleation surgery. Gentle and careful handling of tissues leads to superior cosmetic results and fewer complications. Extrusion of orbital implants may occur early or late. Sm...Careful surgical technique is important in enucleation surgery. Gentle and careful handling of tissues leads to superior cosmetic results and fewer complications. Extrusion of orbital implants may occur early or late. Small extrusions may be treated with a scleral patch, and larger extrusions with an acrylic sphere wrapped in fascia lata or donor sclera. Dermis fat grafts are also satisfactory secondary implants.
Throughout history, the human eye has been mentioned by authors as the most precious of gifts. It unveils the entire outer world to our consciousness, gives life expression and dignity to the face. The loss of an eye mus...Throughout history, the human eye has been mentioned by authors as the most precious of gifts. It unveils the entire outer world to our consciousness, gives life expression and dignity to the face. The loss of an eye must therefore have always been regarded as the greatest misfortune. The ancient cultures of Babylon, Jericho, and Egypt used "art-eyes" in mummies, sarcophagus lids, and statues; they were made from precious stones, silver, gold, and copper as a symbol of light and life in their religious beliefs. Most of the recorded sources concerning the ancient practice of medicine were among the scrolls contained in the library of Alexandria. In the period between the Roman Colonial wars, the rise of Christianity and the fall of Alexandria to Arabs in 642 A.D., almost all of these sources, including those concerning the practice of Ophthalmology were lost. The largest collection of antiquity "art-eyes" and artificial eyes, mentioned in this paper, are found in the collection of the firm of Mueller and Sohne, Wiesbaden, Germany. They include the progress made in human artificial eyes to modern times. Historically, man has tried to alleviate the psychological suffering incurred by the loss of an eye, by hiding or covering the defacement with a patch. Of greater significance are the efforts made by the ophthalmologist and the ocularist (past and present) to restore functionally and cosmetically the natural facial appearance by means of an ocular prosthesis that corresponds to the remaining natural eye. Associated problems frequently concern both the reconstructive surgeon, who must be informed of the ocular prosthetic possibilities that are within the capacity of the ocularist, and the ocularist, who must create the prosthesis.
Newer trends in enucleation surgery have included placement of the orbital implant deep within the muscle cone. The use of homologous or autologous tissue to wrap the implant has aided in decreasing extrusion. Newer impl...Newer trends in enucleation surgery have included placement of the orbital implant deep within the muscle cone. The use of homologous or autologous tissue to wrap the implant has aided in decreasing extrusion. Newer implant materials show promise in reducing extrusion and in creating an integrated motility implant.
This article considers the complications of orbital trauma surgery. In addition, ocular as well as nonocular complications of orbital trauma are outlined. Knowledge of the workup of specific types of orbital fractures wi...This article considers the complications of orbital trauma surgery. In addition, ocular as well as nonocular complications of orbital trauma are outlined. Knowledge of the workup of specific types of orbital fractures will help prevent common sequelae of unrecognized orbital fractures: (a) orbital contour abnormalities, and (b) late enophthalmos. Complications of orbital fracture repair that relate directly to the alloplastic implant include (a) orbital cellulitis due to an infected implant, (b) anterior extrusion of the implant, (c) compression of the optic nerve by the implant, (d) dacryocystitis due to obstruction of the lacrimal sac by the implant, and (e) late proptosis due to hemorrhage into the fibrous capsule that surrounds the implant. Surgical techniques that minimize such complications are emphasized.
A method for the clinical evaluation of patients with orbital and midfacial fractures is presented. Pertinent anatomic relations, classification of fractures, and significant associated injuries are reviewed. Principles...A method for the clinical evaluation of patients with orbital and midfacial fractures is presented. Pertinent anatomic relations, classification of fractures, and significant associated injuries are reviewed. Principles of treatment are offered.
During a period of six years (1981-1987) we have used the Nelson stainless steel screw for fixation of the medial canthal tissues to the medial orbital wall in nine patients and in the lateral wall in one. No complicatio...During a period of six years (1981-1987) we have used the Nelson stainless steel screw for fixation of the medial canthal tissues to the medial orbital wall in nine patients and in the lateral wall in one. No complications have occurred in any of the patients, and we endorse its use.
Orbital-cranial injuries have the greatest potential for death and disability of any condition treated by the ophthalmologist. An object that penetrates through the orbit into the brain may leave only a small entrance wo...Orbital-cranial injuries have the greatest potential for death and disability of any condition treated by the ophthalmologist. An object that penetrates through the orbit into the brain may leave only a small entrance wound. Patients can have normal vision, neurologic exam, and plain x-rays despite trauma that may lead to meningitis, brain abscess, or pneumocephalus. The CT scan greatly aids in both the early and late management of blunt and penetrating orbital-cranial trauma. The detection of pneumocephalus may be the only clue that intracranial penetration has occurred. Blunt trauma can cause vision loss, ophthalmoplegia, ptosis, and intracranial injury. Management of orbital-cranial trauma frequently requires a team approach by the ophthalmologist and neurosurgeon due to the complexity of these injuries.
The term naso-orbital fracture refers to the backward displacement of the nasal bones into the interorbital space. The fracture is most commonly the result of traumatic contact with the dashboard in automobile accidents....The term naso-orbital fracture refers to the backward displacement of the nasal bones into the interorbital space. The fracture is most commonly the result of traumatic contact with the dashboard in automobile accidents. The trauma results in soft tissue eyelid deformities, which may also involve nasolacrimal disruption and life-threatening intracranial injury. Early management consists of closed reduction of the nasal fracture when feasible. Late management, which is more common, consists of transnasal wiring, restoration of the nasolacrimal apparatus, and contouring of the nasal bones.