Primary Embryonic Stage
When the congenital anomaly is the absence of an eye and/or
partially formed eyelids it is far more complex to manage,
because the bony orbital wall and facial features never completely
developed. Our method of non-surgical augmentation
of the orbital area and the eyelid aperture (with pressure
stem conformers) is an accepted standard of treatment, and
is practiced by other Board Certified Ocularists and members
of the American Society of Ocularists. Because of the
number of laboratory fitting sessions and the length of time
it takes before the first ocular prosthesis is fitted, it
is recommended parents seek this service from an ocularist
close to their home.
This first case presents bilateral narrow bony orbital walls
with micro-eyelids that were slit-like, firm and taut, with
entropion (inversion) of the lower eyelids and lashes.
When the eyelids are separated there is no eyeball present
and the socket is funnel shaped lacking definition of culs-de-sac
or fornices (internal eyelid formation). This is the
earliest of prenatal stage aberrations. The cavity
will neither retain nor self-support any type of prosthetic
device without first applying (long-term) external force
to the orbital void with empirically fitting a series of
incremental sized and shaped pressure stem conformers.
The object its to gradually expand the eyelid aperture while
trying to create fornices (the under part of the eyelid).
The projected time span before an ocular prosthesis can be
retained is usually 1 to 3 years.
This display of five bilateral incrementally larger empirically
fashioned pressure stem conformers indicates the upper series
for the right socket began with a slightly larger cavity
and retained that rate of expansion throughout the fitting
The first pair of conformers was fitted when the child was
3 months old. In order to retain the stem conformers,
tape was applied across the brow to the cheek. This
also prevented the child from rubbing them out of the cavities.
The conformers also remained in continuously, with exception
The first self-retained prosthetic models were trial fitted
one year later, but the largest pressure stem conformers
were still utilized at bedtime as a precaution not to lose
any orbital space gained. (Note the narrow fissure-left
eye, with marked entropion of the lower lid.)