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Case study 1

Glossary of terms:
Eye evisceration : An operation whereby the iris is incised away allowing the eye-ball to drain and collapse.
Endophthalmitis : An inflammation of the internal coats of the eye.
It is a dreaded complication of all intraocular surgeries, particularly cataract surgery.
Atrophy : A wasting away of part of the body

Background:
Susan Henshaw (not her real name) is an attractive 60 year old who lost the sight of her right eye in 2002 due to endophthalmitis following a corneal transplant operation. For two years Sue’s damaged eye became more and more disfigured, but she could not face having it removed.

It was very hard for me. Eyes are the windows of the soul. It is much harder to lose an eye than to lose other body parts because of the emotional aspects.”

Sue could not find the advice she needed but in the end her GP introduced her to a woman who had lost her eye some years before. This woman had had her prosthesis made by Keith Pine and was able to tell Sue that wearing an artificial eye was not as bad as most people thought. This information was enough for Sue to pluck up the courage to go ahead with the evisceration of her eye. She felt better after making the decision but wishes that some professional counseling had been available to help her. After the socket settled down from the operation Keith Pine finished her prosthesis:
I should have had my eye out sooner. I wish I had not put myself through such prolonged emotional turmoil.”

Now, four years later Sue has just received her second artificial eye. Her initial fears are behind her and she is no longer shy about meeting clients at work or with anything else in her busy life.

Even if I told people about my artificial eye (which I wouldn’t), they would not believe me – if I told them I am 60 years old (which I wouldn’t), they would not believe that either.”

Review of prosthesis and socket:
When Sue attended her annual appointment for checking and re-polishing her artificial eye in March 2008, it was obvious that her socket had changed shape. The prosthesis was comfortable but gazing outward due to atrophy of the remnants of her eviscerated eye. Sue was referred to Dr Brian Sloan*  for his opinion before Keith Pine commenced making her a replacement prosthesis in October 2008.

Treatment:
The new prosthesis addresses the outward gaze but also carries a prominent ridge on the upper edge in order to fill out some of her deep upper lid sulcus. The artificial eye is comfortable to wear and, as with most eviscerated sockets, has an excellent range of movement (see photos). Sue was advised to continue to remove and clean her prosthesis every month or so. She will be recalled for a check and re-polish in twelve months time. Sue’s artificial eyes are fully funded by ACC. Best wishes for your future Sue and may your body and soul stay young forever.

* Dr Brian Sloan, Ophthalmologist at Milford Eye Clinic, 181 Shakespeare Rd, Milford, Auckland.

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