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 Procedure > Instruction for Removal of Scleral Trial Shell From a Dysfunctional Globe  
 

Removal of Scleral Trial Shell or Prosthesis from a Corneal Sensitive Globe
(Instructions for Patient)

Method 1 - Removal Technique with Suction Cup:  The best method for removal of a scleral cover shell from a corneal sensitive eye is with the use of a suction cup.  Unlike the insertion where the fingers have the most control, removal is better controlled with a suction cup.  The reason being it may be more difficult to grasp the edges of the shell without fingernails, or conversely you may irritate the underlying globe with long fingernails.

Step 1. All Important Hygiene Care

  1. Scrub Hands and Fingertips:  A thorough hand scrub with emphasis on the fingertips is necessary to prevent introduction of bacteria to the eye.  We recommend using a 'no more tears' baby shampoo for this cleansing process, because it destroys bacteria.
  2. Hygiene for Eyelids and Lashes:  Another source of bacteria and irritation to the eye is the crusting of secretions on the eyelids and eyelashes, so it is best to clean this area prior to insertion of the shell.  Apply a warm wet facecloth with the 'no more tears' shampoo on the eyelids.  Let it remain for a few moments to soften the crusted secretion, then wipe it clean.  There should be no concern about stinging or smarting of the eyes, since the shampoo has a neutral pH.

Step 2. The Eye Position:

Set a mirror at an angle so you are looking downward to see your image.  (The scleral shell will also be in a downward position.)

Step 3. The Suction Cup:

Moisten the open end of the suction cup with water and squeeze it halfway up the barrel with your thumb and index finger.

Step 4. Elevate the Upper Eyelid:

Place your index, forefinger or thumb (whichever is more comfortable, and does not obstruct your vision) of your free hand on the upper lid and eyelashes.  Pull the eyelid toward the eyebrow.  This should expose the upper edge of the scleral shell.

Step 5. Placement of Suction Cup:

Set the suction cup flush against the front upper part of the shell, and then release the squeezing.  The suction cup should be attached to the scleral shell.

Step 6. Removal of Scleral Shell:

The suction cup is then held lightly (so not to break the suction).  The prosthesis is then pulled away from the eye and the upper eyelid in one quick motion as you return to a frontal gaze.

Method 2 - Removal Technique with the Fingers:  Although, not favored by this laboratory, the scleral shell can be removed with the use of the index fingernail and the thumb of the wearer.  The target site for removal is the outer peripheral edge of the scleral shell.  Fortunately, for this technique, the scleral shell prosthesis does not extend beyond the inner and outer canthus, and can be located quite easily just by touch for the visually impaired.

Tip your head downward, while spreading your eyelids apart with the thumb and forefinger of one hand.  Look nasally, then with the other hand, draw the back of the index fingernail across the front of the shell until it is in contact with the temporal peripheral edge of the scleral shell.  Slide the fingernail past the edge and draw the shell away from the eye.  Gravity should help it slip out, if not you may have to use the thumb to grab the shell.

 

 

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