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.