Exophthalmic Globe with Hypersensitive Cornea
(Rx: Conjunctival Flap)
This young boy was born with an oversized globe with a sensitive
cornea that could not tolerate a cover shell. The parents
did not want him to lose the eye even though it was blind
and unsightly, but still wanted him to have an improved appearance.
A conjunctival flap was performed to cover the cornea, thereby
desensitizing it. The next step was to fit a very thin
scleral cover shell type prosthesis with a slightly larger
iris diameter to give the illusion of palpebral fissure symmetry
even without cosmetic optics. (Presented before the
ASO: Lecture #774 'Ocular Prosthetic Problem Solving')
Figures 6A & 6B
The exophthalmic right eye with a corneal conjunctival flap
also shows inflammation of the conjunctival tissues following
the flap procedure. This shows frontal and upward gaze.
Figures 6C & 6D
The exophthalmic right eye with the flush fitting scleral
prosthesis matches the normal scleral white, tints and vascular
pattern with an oversize iris to also give balance to the
eye aperture. The irregular conjunctival flap surface
aids in producing responsive motility to the overlying flush
fitting scleral cover shell prosthesis.
Figures 6E & 6F
Note how the flush fitting scleral shell is synchronized
with lateral excursion of the fellow eye. To make the
cover shell prosthesis less detectable the peripheral edges
in the horizontal plane are 'feathered' from the scleral
white to clear acrylic to blend in with the underlying conjunctiva
in the canthi.