The response of the anophthalmic socket to prosthetic eye wear

Abstract

Purpose: The aim of this study was to investigate the inflammatory response of the anophthalmic socket to prosthetic eye wear. Methods: One hundred and two prosthetic eye wearers were recruited for this observational study. Photographic grading scales were used to measure the severity of conjunctival inflammation and the extent and intensity of stained deposits on the prosthetic eyes. Tear volume was measured with the phenol red thread test. For mucoid discharge, visual analogue scales were used to assess frequency of occurrence, colour, volume and viscosity. For the prostheses, assessments were made of weight, shape, wearing time and frequency of cleaning. Results: Anophthalmic sockets had more severe conjunctival inflammation than their companion eyes (p = 0.0001). The difference in inflammation between the companion eye and the anophthalmic socket was associated with discharge volume (p = 0.01) and discharge viscosity (p = 0.007) with greater difference in inflammation being associated with higher levels of discharge volume and viscosity. A greater difference in inflammation was also associated with less surface deposition (p = 0.009). No evidence of associations was found between difference in conjunctival inflammation and the other variables. Conclusions: Recently developed grading scales for measuring inflammation in anophthalmic sockets and deposits on prosthetic eyes were used for the first time in this study. It is recommended that in clinical practice, inflammation grades for both socket and companion eye conjunctivae be compared, when determining if prosthesis-induced inflammation is present. The finding that more discharge was associated with more conjunctival inflammation is logical but the finding that less inflammation was associated with more deposits is counter-intuitive to those familiar with the contact lens literature. The apparently benign nature of at least some deposits on the prostheses raises questions about the maintenance of prosthetic eyes. We conclude that the simple presence of deposits is unlikely to be linked with inflammation of the conjunctiva in wearers of prostheses, who like those in this study, cleaned their prostheses regularly but not frequently.

Augenprothetische Versorgung

“…Nach dem Abhärten des Gipses wird das Wachs entfernt, und man erhält eine Negativgussform. In diese wird wiederum flüssiger PMMA-Teig hineingegeben, der dann bei 72 °C polymerisiert und aushärtet [6]. Bei der Kunststoffaugenanpassung mittels "Fitting Set" wählt der Okularist ähnlich wie der Glasaugenprothetiker aus seinem Sortiment von PMMA-Modellaugen ein bezüglich der Form annähernd passendes Auge aus.…”

“…Abb. 3f) ist deutlich zeitaufwendiger (insgesamt etwa 3 Tage) als die Herstellung von Prothesen aus Glas und erfordert bei individuellem Augenhöhlenab-druck mehrere Sitzungen mit dem Patienten [6]. Unter Verwendung eines "FittingSets" ist der zeitliche Aufwand für den Patienten mit meist nur einer Sitzung von 2-3 h jedoch geringer [24].…”

“…Vor diesem Hintergrund erscheint eine reibungslose Rehabilitation durch Anpassung einer Augenprothese umso essenzieller. Letztere erfüllt nicht nur kosmetische Funktion, sondern gewährleistet eine normale Lidstellung und -bewegung, somit die palpebrale Reinigungs-und Benetzungsfunktion, und verhindert durch Ausfüllung des Bindehautsackes ein stark beeinträchtigendes Pooling des Tränensekrets mit plötzlichen Sekretentleerungen [6].…”

Patient Evaluation

“…Anophthalmic socket assessment should continue with measurements of conjunctival infl ammation which has been reported to be found in 69 % of sockets with prostheses [ 17 ]. As conjunctival infl ammation of the socket has many causes other than those related specifi cally to prosthetic eye wear (e.g.…”

“…The visual analogue scales may be used to facilitate the measurement and recording of the colour, viscosity, volume and frequency of mucoid discharge (Fig. 4.46 ) [ 17 ].…”