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Methodology
In evaluating the anophthalmic socket
of any patient, particularly in an elderly
patient, one must consider several fac-
tors that will impact the final result. It is
common to find problems with lower-lid
laxity leading to retention issues and
midline misalignment of the pupils on
the horizontal plane; superior sulcus
defects, which cause a hollow appear-
ance of the superior sulcus; upper-lid
laxity, which creates the need for a ptosis
crutch; weight considerations, which
exacerbate lower lid laxity as the weight Figure 5. Ocular prosthetic modifications.
of the prosthesis pushes the lower lid
downward and out of position. In all, one must take
into account the option of surgical intervention
to correct these anatomical defects. The author’s
experience with recommending that a patient
attend a consultation with the referring physician to
discuss possible surgical intervention has been, in
the majority, negative. Elderly patients seem to be
extremely reticent to have additional surgery and for
the most part cannot afford even the copay.
In this present case study, the author chose the
standard-impression technique using an impression
tray. The patient was asked to incline his head at a
45-degree angle upward as the impression material
was initially injected through the tube attached to
the front of the impression tray. Then he was asked
to slowly tilt his head down in a forward-looking
position as the impression material set. It is stan-
dard practice in the author’s experience to mix the
impression material to a medium viscosity in these
circumstances. The impression was cast using
fast-set Jeltrate (Dentsply Sirona; Charlotte, North
Carolina ), the impression was removed; the top and
bottom portions of the mold were put back together; Figure 6. Patient wearing the
and the void was filled with Ivory Inlay Casting Wax 2018 custom ocular prosthesis.
(Kerr Laboratory, Brea, California). Note that Ivory
Inlay Casting Wax is recommended by the author
because of its capacity to be easily carved as well as the best cosmetic result would require some degree of
its non-brittle properties. asymmetry between the natural and the artificial eyes.
The wax model was trimmed, smoothed, and It was suggested to the patient that a blepharo-
inserted into the patient’s eye socket to be evaluated. plasty procedure on the lower lid to raise the lid and
It was determined that additional material would position the prosthetic eye higher in the socket might
need to be removed from the portion that extended result in a higher degree of symmetry between it and
into the lower fornix to allow the lower lid to slide the companion eye. His response was to say that he
upward. Due to the displacement of the adipose had no interest in any type of surgical intervention.
tissue and the overlying skin surrounding the eye The author proceeded with modifications to the wax
socket, eyelids, and cheek, it was determined that model. Figure 5 shows a comparison, in silhouette, of

18 | SANDERS JOURNAL OF OPHTHALMIC PROSTHETICS