An 18-year-old female patient reported to the Department of Prosthodontics for prosthetic rehabilitation of her lost left eye. On eliciting history, it was found that the patient had sustained a shrapnel injury to her left eye, which necessitated a surgical evisceration of the eye. Clinical examination revealed a completely healed left eye socket. Her right eye had normal vision. The patient had no other relevant medical history [].\nA custom ocular tray was made by pouring autopolymerizing resin into an alginate mold made with a stock ocular prosthesis. Perforations were made in the custom ocular tray to aid in retention of the impression material, and a tunnel was cut out at the center of the custom tray to which a disposable impression tip was attached to deliver the impression material[] The impression was made by injecting light bodied addition silicone material (Aquasil Dentsply) through the prepared tunnel[] []. The patient was asked to move her eyes in all directions to facilitate flow of impression material into all aspects of the socket. Then, the patient was asked to look directly at a fixed point six feet away at the level of eye allowing impression of the site with the muscles in neutral gaze position The impression was invested first in dental stone till the height of contour and when set a second pour to create a two piece split cast mold[] [] A wax conformer was fabricated by pouring molten baseplate wax into the two pieces split cast, after which it was retrieved and the sharp edges were removed.[] The rubber stopper from a plunger tip of a tuberculin syringe was used as a removable cap which was fitted into an opening made in the posterosuperior aspect of the wax conformer A bevel was placed around the margins of the cap to help in easy removal and placement []. The wax conformer was then adjusted for the satisfactory fit, contours, and comfort An iris disk cut out from a stock eye was attached to the wax conformer using a transparent grid[] [] A needle cap was attached with cyanoacrylate adhesive to the iris disk []: To assess orientation of visual axis To stabilize and secure the iris disk during dewaxing and packing. A wire was attached to the rubber cap so that the rubber cap was retained in the same position during dewaxing and packing [] The prosthesis was invested in a dental flask. Upon separation of the flask after dewaxing, the rubber cap was retained in position by the attached wire and iris disk was retained in position by the needle cap which was attached to it [Figures and ] A mixture of clear heat cure acrylic resin and zinc oxide eugenol was packed to achieve a white scleral color.[] Lost salt technique was used to create a reservoir for the lubricant in the superior aspect of body of the ocular prosthesis[] [] A modified curing protocol (reverse curing cycle) was followed to minimize the monomer content of acrylic eye.[] In this technique, the flask was placed in water at 95°C × 20 min and thereafter in boiling water for additional 20 min The ocular prosthesis was acrylized, retrieved, and finished. All residual salt crystals were flushed out through the opening for the removable cap The prosthesis was tried to check for the extent, fit, comfort, and iris position. Characterization of the scleral part of the prosthesis was done with the help of (SR Adoro) light cure stains and (Targis Power) light curing unit so as to match the natural eye. Optiglaze protective coating agent (GC America) was applied to protect the characterization [] A 0.5 mm diameter exit hole for the lubricant was created on the anterior surface of the ocular prosthesis into the limbus with the help of a suitable bur which connected the reservoir containing the lubricant The prosthesis was disinfected in cidex :2% glutaraldehyde cidex (surgikos, Johnson & Johnson co.), and it was delivered to the patient with instructions as to how to load the lubricant (carboxymethylcellulose eye drops IP 0.5%, extralube).[] [Figures –]. The removable cap is to be replaced if there is deformation or tear such that it does not fit into the access passage or there is a leakage of lubricant. Patient was instructed to clean the prosthesis with ophthalmic irrigation solution.[] The chamber was cleaned by removing the removable cap and injecting ophthalmic irrigation solution through a syringe Patient was followed up after 24 h, 1 week, 1 month, 3 months, and then every 6 months. The removable cap was replaced after 6 months due to deformation.
A 42-year-old male patient was referred to the Department of Prosthodontics and Crown and Bridge, Mahatma Gandhi Dental College and Hospital, Sitapura, Jaipur, India. The patient complained of missing right eye which was enucleated following an accidental traumatic injury []. Consequent to this, patient worded dark glasses specs for almost 1 year but at the same time, he was suffering from severe emotional trauma in terms of facial esthetics and social acceptance. Hence, the patient was seeking artificial eye replacement. On examination, defect with a shrunken orbit and intact tissue bed were observed. As the patient was economically very poor, the modified stock ocular prosthesis was advised. The treatment procedure and its limitations were explained to the patient to allay apprehension and elicit cooperation.\nA transparent, vesseled stock eye was selected with a close resemblance of the iris of the stock ocular prosthesis with that of the natural eye using both daylight and artificial light.\nAn ophthalmic socket was anesthetized with topical anesthetic followed by light lubrication of same side eyebrow and eyelashes to make the procedure more comfortable.\nA customized impression tray with injector was fabricated by joining hub of 10 ml syringe with perforated head of disposable plastic spoon using an adhesive. Later customizing and smoothening of corners of perforated head part according to the dimensions of anopthalmic socket of defect side was done [].\nThe primary impression of an ophthalmic socket was made using customized injector, by injecting the light viscosity addition elastomeric impression material (Virtual, Light body, Ivoclar Vivadent, India) slowly (to avoid any air bubbles), first into the depth below the upper eyelid and then into the lower. The patient was instructed to close his eye so that the excess material could flow out through perforations in the trays. While the material sets, instructions were given to the patient to do various eye movements in following order-moving eye laterally, followed by up and down motion and finally in a circular motion After the impression material had set, it was carefully removed from the anophthalmic socket The impression was checked to ensure that all the surfaces are recorded and there is no porosity present. This was followed by beading and boxing (Beading and Boxing wax, MP Sai Enterprises, India) of impression []. Investing with Type IV dental stone (Kalrock, Kalabhai, India) was done to obtain a primary cast Customization of the stock ocular prosthesis was done by selectively grinding and making it 2 mm short all around the margins of primary cast Border molding and secondary impression of the patient's anopthalmic socket was made by modified wax (sticky wax and utility wax in the ratio of 1:2). The objective was to obtain complete peripheral contact and proper curvature [] Centralization of the iris was checked by asking the patient to look straight ahead to a distant object, keeping in mind the symmetry with the iris of the adjacent unaffected left natural eye of the patient Now this wax modified stock ocular prosthesis was removed gently from the anophthalmic socket and was used to make sectional putty (Aquasil, Soft putty, Dentsply India Pvt. Ltd.) indexed mold (indexing of the first section was done so as to allow correct orientation of the second half of the mold) using putty viscosity addition elastomeric impression material []. This mold was used later for processing of definitive ocular prosthesis After the putty material had set, the two halves of putty mold were separated and the wax modified stock ocular prosthesis was retrieved so as to keep the mold space ready for processing of definitive ocular prosthesis []. Holes were made on second half of the mold to release excess resin to flow out The Modified wax was completely removed from the wax modified stock ocular prosthesis, which was followed by placing back of same ocular prosthesis into the first half of the sectional putty indexed mold in such a manner that inner surface faces upward []. Proportioning of clear and tooth colored auto-polymerizing methyl methacrylate resin (Dental Product of India (DPI), self-cure tooth molding powder and liquid, India) of appropriate shade was done in such a manner that resultant mixer matches with the color of the sclera of the unaffected eye of the patient. This resultant mixer was poured over the inner surface of wax modified stock ocular prosthesis []. Final packing was completed by tightening of second putty mold over the first mold. Excess material flows out through holes prepared and were removed. Acrylization was done by keeping sectional putty indexed mold into pressure pot at 30 psi for 20 min for complete polymerization, preventing any excess unreacted monomer, essential to prevent any untoward irritation or sensitivity and thereby a rejection of the prosthesis by the patient. This also enables the minimization of porosities and gives a good finish to the prosthesis as the eye socket is extremely sensitive and the residual conjunctiva and related structures react to any surface roughness and irregularities After complete acrylization, sectional putty indexed mold were opened and definitive ocular prosthesis retrieved []. The prosthesis was inspected for imperfections. Finishing and polishing were done to get a glass like finish to achieve maximum adaptation and overall success of the prosthesis []. The ocular prosthesis was washed with warm water and soap and inserted into the patient's anophthalamic socket and evaluated critically for lid drape, contour, and dimension\nThe final outcome of the prosthesis was ascertained from the satisfied look on the face of the patient and from the follow-up a week later. Instructions regarding ocular prosthesis were given as follow:\nCareful handling of the prosthesis with clean hands Removal of the prosthesis once a day, if necessary, and to wash it under warm water with a soft clean cloth and mild soap Cautioned to keep the eye moist by placing it in water if it's not in the anophthalmic socket, and never to allow it to come in contact with alcohol, or solvent of any kind Examination of anophthalmic socket once in a year or instantly when there is any irritation To improve the movement of the eyelids and the sparkle and sheen of the prosthesis, its beneficiary to use silicone base lubricant or mineral oil or safflower oil.[]