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Welcome Prospective Scleral Cover Shell Wearers

This informative site is constructed for the parents of children with congenital microphthalmos (partially developed eye), and for those who had vision, but were less fortunate following surgery to have lost it, and now have an acquired phthisical (shrunken globe).  In both instances, there is facial asymmetry, one with a narrow micro-lid margin, the other with pseudoptosis (lid droop) and enophthalmos (sunken in appearance).  Once these problems are presented, a solution must be sought.

The Old Solution:  At the beginning of the 20th century, the solution for microphthalmos and phthisis was to enucleate and be fitted with a conventional glass eye.  The reason for this was fear that the dysfunctional globe may be harboring a tumor, and it could not be detected with ophthalmoscopy (visual examination) due to opacities of the ocular media.  If, one elected to forego further surgery and keep the dysfunctional globe, the options were; an eye patch, dark glasses, or risk wearing a thin nonconforming glass shell eye that could not offer much for wearing comfort with improved cosmesis.

The New Solution:  It has only been within the last half of the century that medical and technical advances in ophthalmology, (ultrasonic equipment became available as a diagnostic aid to detect orbital tumors), that made the patient's 'option of chance' for retention of the dysfunctional eye to become the 'option of choice.'  Simultaneously, ocularistry had made several advances (the impression moulding technique and acrylic for prostheses).  This was the beginning to a better solution, so, as ophthalmology began to form subspecialties in pediatrics and retinal surgery it prompted ocularistry to stay abreast.  In fact, it was responsible for this subspecialty, the 'varied thickness impression moulded scleral cover shell.'  To accomplish this, it required mastering a new iris painting technique (refer to Procedures: Description for Phase II Scleral Ocular Prosthesis) for some prostheses as thin as a fingernail.  But, when this is all combined, it provides prosthetic wearing comfort and improved cosmesis, with its flush posterior fit, and its sculptured front surface for restored anterior projection and palpebral symmetry.

Despite the additional time and painstaking effort to fashion an exact fitting scleral prosthesis, most ocularists will agree, there are more advantages for retaining the microphthalmic or disfigured globe.  Foremost, you are not losing a facial part, followed by no further disturbance of either the intraocular and extraocular muscles, or the orbital contents (conjunctival and adipose tissues).  The disfigured globe will also provide better motility of the overlying prosthesis, than many implants in use at this time.  Whereas, surgical removal of the microphthalmic eye is of no advantage, since the rectus muscles are too small to attach to a motility implant.  And, enucleation of the phthisical globe (with its conjunctival adhesions) may create some eyelid and socket fitting problems, such as, superior sulcus depression, lack of an upper tarsal lid fold, and incomplete closure of the eyelids.

Some Commonly Asked Questions:

A complete list of all frequently asked questions about ocular prostheses may be found in our FAQ index.  As always, if you need a specific questions answered, please ask any of our staff ocularists.


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Jahrling Ocular Prosthetics, Incorporated
50 Staniford Street, Boston, MA  02114, USA
Members American Society of Ocularists, Board Certified Ocularists