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Case study 3

Take home message:
You don’t have to put up with an uncomfortable prosthesis.
Ensure that you a following a regular maintenance regime.
Sometimes oculo-plastic surgery is needed to improve socket comfort.

Glossary of terms:
Phthisical eye : A condition of the eyeball that may result from injury when the eye loses function and shrinks in size.
Entropion : A condition whereby the eye-lids fold inward.

Background:
Diane Wood (77) has worn an artificial eye since her right eye was enucleated by at age 12. She was only 18 months old when her eye became infected, then discoloured and phthisical. Diane’s first prostheses were made of glass and she well remembers selecting her glass eyes from an assortment laid out on trays. She also remembers breaking her glass eye and the drama and stress this caused her poor mother who had to rush her to the optometrist to find a replacement. Diane was always told to clean her prosthesis daily and to take it out at night to ‘rest’ the socket. One morning she couldn’t find her eye and got into a right old state because nobody had ever seen her without her prosthesis. She has vivid recollections of ripping her bedroom apart before discovering the eye mixed up in her blankets. In spite of the difficulties with her eye, Diane has achieved a full and rewarding life. She had a long and successful career as a sales representative in the printing and office furniture industry and has 3 children, 9 grandchildren and 1 great grandchild. Having only one eye has not prevented her from doing anything she would not have done otherwise – “it just felt different.”

Review of prosthesis and socket:
Diane presented for a review of her artificial eye and socket. Her prosthesis (made elsewhere a few years ago) was too small, gazing inward and unstable. Diane also had chronic mucoid discharge, aggravated by upper lid entropion which caused her continuously wet eye-lashes to stick to the prosthesis.

Diane’s right prosthetic eye – note the upper eyelashes rubbing against the prosthesis.

Treatment:
A new prosthesis was provided. This eye fitted the socket better than the previous one, albeit that the upper eyelid entropion was still a problem (see photo) affecting both appearance as well as comfort. Diane was referred to an ophthalmologist for advice about this. Diane was given new instructions concerning the ongoing maintenance of her eye and socket. She was told to leave the eye in place night and day and to only take it out for cleaning every month or so. This advice contradicted everything she had been told previously but she adhered to it. After two weeks she wrote the following note to Keith Pine:

Dear Dr Pine,

I just cannot find an adequate way to express my feelings – quite unbelievable that after 70+ years I no longer have the horrors/fears of dropping or losing my eye. And the daily ‘mucky build up’, scratchy, worrying, unsightly, itchy. Now I actually do feel I have two good eyes. The change in caring/cleaning! I can forget all about it – go places, buses etc. What a miracle!  Oh dear, I am too thrilled. I wish you all the very best,
Diane Wood

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