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Cosmetic Optics: The last linkin the chain of cosmetic rehabilitation
The condition of the socket following disease (or injury) and surgery may not allow even the most skilled surgeon/ocularist team to produce a completely natural-looking artificial eye. The practitioner must therefore employ special techniques , known as “cosmetic optics”, to give the best cosmetic result for the artificial eye.
Adjusting the lid opening
In cases of a too-narrow or too-wide lid opening, the use of a cylinder lens, by itself or in combination with plus or minus power lenses, will change the apparent shape of the lid opening. If the patients lid opening is too wide, start by holding a –3.00 cylinder over the patients artificial eye at axis 180, and then rotate the lens slightly in different directions. You will see the lid shape change and take on a more narrow look. Holding the lens at axis 90 will produce the opposite effect. The use of a minus cylinder to narrow the lid opening can also cause the iris to look smaller. In such cases, adding plus sphere power will neutralize this effect.
Adjusting orbit height Anophthalmic patients often appear to have a sunken socket due to lower lid sag (from an unpegged artificial eye), an inferior orbit “blow-out” fracture, or from atrophy of orbital tissues. In such cases, a prism can be used to raise the apparent height of the orbit. One dioptre of prism base down will raise the orbit by 1.0mm. However, since the prism may add significant weight to the lens, special consideration should be given to frame selection. A frame that is too large will result in a thick edge and a heavy look. It is definitely possible to raise the orbit with prism, but if the end result is unacceptable, then the benefit is lost. Ocularists, especially those with a background in optics, are often aware of the capabilities of cosmetic optics. Improved awareness and communication between our specialities will ensure optimum cosmetic rehabilitation of the anophthalmic patient. Excerp from “Movements” volume 4 |
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