Case study 7

Take home message:
Sudden, brutal damage to an eye is devastating but you must believe things will get better.
Scleral shells fit over the scarred remnants of blind eyes and have excellent movement, very good retention and are comfortable to wear in most cases.

Glossary of terms:
Atrophy : A wasting away of part of the body.
Sympathetic ophthalmia : An auto-immune eye disease in which a penetrating injury to one eye produces inflammation in the uninjured eye. The injury triggers the formation of antibodies which cause inflammation in the uninjured eye with gradually progressive loss of vision.
Cosmesis : Refers to the correction of a disfiguring defect.

Background:
Alice Morris (not her real name) is one of life’s characters – she is a grandmother, self employed and has an abounding affection for her many friends.”I couldn’t comprehend. Half my vision was missing. For me this was a worse reality thanthe pain I felt when my eye was bashed with the metal bar. I was also frightened when I was told that there was a chanceI could lose my good eye as well” To her great relief, Alice did not lose the sight of her left eye through sympathetic ophthalmia. She was very grateful to her ophthalmologist, Dr Andrew Watts* for achieving this and for saving her damaged right globe from enucleation. Four months after being assaulted, Alice is feeling positive about her future, not least because of her new prosthesis.

“My scleral shell fits over the remnants of my eye. It is very comfortable and you wouldn’t know it wasn’t real.” She now
just wants to put all the events of the last few months behind her. She is dreading having to give evidence at the pending criminal trial because this prolongs the agony of her traumatic experience. She doesn’t even care what happens to the man who brutally attacked her – she just wants to get on with her life.

Review of prosthesis and socket:
Alice’s damaged right eye was first examined by Keith Pine 5 months after her attack. She was still a bit unsteady and not yet confident enough to drive her car or go back to work. Her injured eye had started to atrophy and was still irritated and red. Three weeks later however, the eye had settled down sufficiently to start making her scleral shell.

Treatment:
A scleral shell was constructed from an impression of Alice’s damaged eye. Scleral shells (cosmetic shells) are different from artificial eyes in that they fit over a disfigured globe rather than fill an empty socket. The globe provides an excellent foundation and provided sceral shells can be made thin enough not to appear too large, they often result in a better cosmesis because of their superior movement. The new prosthesis was comfortable and Alice had no trouble getting used to wearing it. She and her family were very pleased with the result and Alice is now fully reconciled to the loss of her eye and confident about her future. Alice’s new scleral shell was fully funded by ACC.

Alice will return in one year for a check and repolish of her shell – it will be a pleasure to catch up with her again to see how she is getting on.