Working with the plastic eye is obviously less expensive and less painful for the patient than surgery, so the first step in addressing post enucleation socket syndrome (PESS) is to update the prosthesis. This may be done by modifying the existing prosthesis or by replacing it.
When as much as possible has been accomplished by the prosthetist, the eye surgeon can use the updated eye as
a baseline from which to assess and measure further corrections. It is often necessary for the patient to be referred
back to the prosthetist for final modification of the artificial eye following socket surgery.
The object is to create a prosthesis with a shape that increases the height of the upper lid, corrects the direction of gaze and takes pressure off the lower eyelid. The size of the prosthesis is increased by bringing the iris/corneal unit bodily forward and angling it to ensure a level gaze. The anterior surface is then made as conical as possible. This reduces bulk and lightens the prosthesis, and at the same time, wedges the eyelids apart and increases the opening.