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Case Study No. 2
In February 2019, a 60-year-old female came into
our office unable to insert her prosthesis, which had
fallen out approximately 2 weeks before her visit. Her
prosthesis was considerably larger than her eye socket,
which had rapidly contracted. We were able to insert a
small conformer made from an iris button. In addition
to the socket being contracted, this patient’s eyelids
tended to roll inward. She was scheduled to return
the next week to attempt a larger conformer fitting,
but she was not able to return until 2 months later.
At that time, we fit her with a small conformer, which
was approximately 10 mm in width and height (Figure Figure 9. Patient wearing small conformer made
9). This patient remained inconsistent about making on April 1, 2019.
or keeping appointments due to limited access to
transportation. Our next step occurred 3 months later
when we fit a small temporary prosthesis. The iris col-
or was incorrect (brown), but nevertheless it boosted
the patient’s optimism that she could “wear an eye”
(Figure 10). One month later, we fit the patient with a
custom prosthesis (Figure 11). Although the prosthetic
eye still appears smaller than her sighted eye, she is
very relieved and positive about having an accept-
able-looking prosthetic eye. She continues to suffer
from lagophthalmos and entropion, but basically she
is comfortable.

Discussion
Figure 10. Patient’s old prosthesis, conformer,
This long-time wearer of an ocular prosthesis first and temporary prosthesis.
came to our practice in 1995 and received a custom
prosthetic eye. Her next visit to our office was 4 years
later, in 1999, with a complaint of pain in the eye sock-
et. After that, we saw this patient 6 years later, in 2005.
She was wearing a prosthesis made by another
ocularist and wished to be fit with a new prosthesis.
She had an infection and by this time it was apparent
that her inferior eyelashes were rubbing against the
anterior surface of her prosthetic eye. She also was
unable to close the eye completely. We made her a
new prosthesis at that time but could not correct the
entropion or lagophthalmos. She was comfortable
with this prosthesis. Unfortunately, we lost this patient
for follow-up for the next 14 years until she came in
for appointments in 2019, as previously described. It
is our opinion that this patient might have had fewer
problems, or less severe problems, with her prosthetic
eye had she been able to keep up with regular annual
check-up visits to the ocularist.
Figure 11. Patient wearing her new prosthetic
eye finished September 3, 2019.

36 | LEGRAND JOURNAL OF OPHTHALMIC PROSTHETICS