OPT 033 Ocular Prosthesis PDF - Common Ocular Diseases & Surgery Types

OPT 033: Ocular Prosthesis COMMON OCULAR DISEASE THAT CAUSES REMOVAL OF THE EYEBALL 3. Laser therapy: The common ocular diseases and causes that indicates removal of the eye: - Laser therapy uses lasers to shrink tumors. This t...

OPT 033: Ocular Prosthesis COMMON OCULAR DISEASE THAT CAUSES REMOVAL OF THE EYEBALL 3. Laser therapy: The common ocular diseases and causes that indicates removal of the eye: - Laser therapy uses lasers to shrink tumors. This treatment normally has fewer side Eye tumor effects than surgery or radiation therapy. Choroid melanoma 4. Eye removal: Retinoblastoma - In some cases, the only choice for treatment is to remove the eye. Depth End stage glaucoma perception will be compromised due to the loss of vision, but most people adjust Phthisis bulbi fairly quickly. Anophthalmos Microphthalmos II. Choroidal melanoma Perforation of the cornea. - A cancer that develops in the choroid, the sponge-like membrane at the back of the eye Atrophy of the eye ball between the sclera (the white of the eye) and the retina. (The retina is the light-sensitive Eye injury/ trauma structure at the back of the eye. It sends visual information to the brain.) - The choroid is rich in blood vessels and supplies nutrients to the retina. I. Eye Tumor - Over time, many choroidal melanomas enlarge and cause the retina to detach. This can - also known as ocular tumors lead to vision loss. - a collection of cells that grows abnormally, and it can be - The most common primary intra-ocular malignant tumor and second most common site malignant (cancerous) or benign (noncancerous). of malignant melanoma in the body. a. Metastatic ocular tumor Multimodal imaging of malignant choroidal melanoma: - Common type of eye tumor a. Choroidal melanoma (arrow) with overlying orange - This is a secondary tumor caused by cancer that has pigment. spread from one part of the body to another, often coming from the lung, breast, b. Autofluorescence demonstrating the intense bright bowel, or prostate. signal (arrow) of orange pigment. c. OCT showing dark melanoma with low signal (white b. Ocular melanoma arrow) and overlying subretinal fluid (yellow arrow). - The most common primary adult tumor that forms in the eye. d. A Scan Ultrasound examination showing elevated - Sometimes called "uveal" melanoma or "choroidal" melanoma melanoma (arrow) with acoustic hollowness, thickness - It forms from pigmented cells in the eye and occurs in three main areas of the eye: >2 mm, and shallow subretinal fluid 1. Iris 2. Ciliary body III. Retinoblastoma 3. Choroid. - Retinoblastoma is an eye cancer that begins in the retina — the sensitive lining on the inside of your eye. Note: These three regions of the eye collectively make up the “uvea”/ Vascular coat. - Retinoblastoma most commonly affects young children, but can rarely occur in adults. Symptoms: Symptoms: Presence of eye moles/ Referred to as “Nevi” or “Nevus” a. A white color in the center circle of the eye (pupil) when light is shone in the eye, such - it develops when certain cells grow together in a group. as when someone takes a flash photograph of the child - an abnormal brown spot on or in your eye. b. Eyes that appear to be looking in different directions - usually develop on the choroid, iris, or conjunctiva of the eye. c. Poor vision d. Eye redness Note: Observe for a spot on or close to the eye growing larger or changing shape or color in e. Eye swelling your patient’s eye, refer immediately to an Ophthalmologist —not all eye tumors are benign. Cause: 1. Benign Eye Tumors symptoms: Genetic mutation: - Choroidal nevi- pigmented lesions which are found inside the eye. - Retinoblastoma occurs when nerve cells in the retina develop genetic mutations. - Choroidal hemangioma - the most common type of noncancerous eye tumor; - These mutations cause the cells to continue growing and multiplying when healthy cells - Symptoms can include redness or vision changes. would die. - This accumulating mass of cells forms a tumor. 2. Malignant Eye Tumors (Melanoma) symptoms: - Flashes of light Progression of retinoblastoma: - Visual distortion - Fig (A) from small intraretinal tumor’s that - Loss of vision can be cured by laser treatment and - Floating objects (floaters) cryotherapy (TNM T1a, IIRC A) - Irregularly shaped pupil - To massive orbital retinoblastoma probably - Glaucoma extending into the brain (TNM T4a-b). - Fig. (B). Child with leukocoria was Treatment diagnosed because of a picture taken (left 1. Benign Lesions/ Tumor (non cancerous) side image) Benign lesions outside of the eye removed surgically via: a. Chemicals Diagnosing cancerous (Malignant) and non-cancerous (Benign) suspected eye tumors: b. Cauterization The following tests will be performed to make a diagnosis of eye cancer. If eye melanoma is suspected, a variety of tests may recommend. Note: Freckles and growths inside the eye are truly determined to be benign, are usually left alone to be examined every 6 to 12 months for any possible changes in growth and color. 1. Eye Exam: - Looking for Enlarged blood vessels on the outside of your eye is usually a sign of a 2. Malignant lesions/ Eye Cancer tumor inside your eye with the help of a binocular indirect ophthalmoscope (BIO). Treatment for eye cancer will aim: - A slit-lamp may also be used to view the interior structures of your eye. a. To reduce the risk of spreading b. To maintain the health and vision of your eye, (if possible) c. Patient’s overall health Treatment plan may include the following: 1. Surgery: - Surgery is common in the treatment of eye cancer 2. B Scan / Eye Ultrasound: 2. Radiation therapy: - An eye ultrasound may be used to produce images of the inside the eye. The ultrasound - Use radiation to destroy cancer cells. Radiation therapy usually consists of a set transducer is placed on a closed eyelid or near the front surface of your eye. number of treatments over a period of time. P a g e 1|5  OPT 033: Ocular Prosthesis a) Older age b) Elevated intraocular pressure c) African ethnic origin d) Positive family history e) High myopia Characteristics of Primary Open Angle Glaucoma: 3. Optical Coherence Tomography (OCT): a. Caused by the slow clogging of the drainage canals, resulting in increased eye pressure - OCT is an imaging test used to create pictures of the inside of the eye. b. Has a wide and open angle between the iris and cornea evelops slowly and is a lifelong Fig. A Pigmented choroidal melanoma with overlying subretinal fluid and orange pigment condition Fig. B Fundus autofluorescence imaging revealing hyperautofluorescence of lipofuscin c. Has symptoms and damage that are not noticed Fig. C Ultrasound depicting hollow tumor 2. Primary angle-closure glaucoma Fig. D OCT showing melanoma with overlying subretinal fluid - Angle-closure glaucoma, a less common form of glaucoma Fig. E subretinal fluid extending into the fovea - The closure is circumferential and begins in the deepest portion of the angle. Closure occurs more evenly in all quadrants Risk factors: a. Older age b. hyperopia c. east Asian ethnic origin Charactiristics of Primary Angle closure glaucoma: 4. Fine Needle Biopsy: a. Caused by blocked drainage canals, resulting in a sudden rise in intraocular pressure - The eye doctor will remove tumor cells from your eye with a needle. as a closed or narrow angle between the iris and cornea - The cells can then be studied under a microscope. - Appositional approximation or contact between the iris and trabecular meshwork - It tends to develop in eyes with shallow anterior chambers, anteriorly positioned or pushed lenses, and angle crowding b. Develops very quickly as symptoms and damage that are usually very noticeable c. Demands immediate medical attention Diagnosed using: a. Ophthalmoscopy and OCT RNFL Note: For patient diagnosed with eye cancer, imaging tests via MRI or CT Scan may be ordered to find out whether the cancer has spread to other parts of the body. IV. End Stage Glaucoma b. Tonometry (Goldmann Applanation Tonometry) - Glaucoma is a heterogeneous group of diseases characterized by: a. cupping of the optic nerve head b. visual-field damage - It is the most frequent cause of irreversible blindness worldwide. - Prevalence rate: Its worldwide age-standardized prevalence in the population aged 40 years or older is about 3·5% Note: - Progression usually stops through lowering the intraocular pressure by 30–50% from c. Gonioscopy baseline. - Chronic forms of glaucoma are painless and symptomatic visual-field defects occur late Ophthalmoscopic photographs of healthy and glaucomatous optic discs Photographs were taken of the right eye. (A) In the healthy optic disc, the neuroretinal rim has its normal shape with its widest part in the inferior region, followed by the superior region and the d. Pachymetry (check for corneal thickness) nasal region, and finally the temporal region (referred to as the ISNT rule). (B) In the glaucomatous optic disc, the neuroretinal rim is strikingly thinner than in the healthy optic disc, and the optic cup is subsequently larger, and the cup is deeper Two common types of glaucoma: e. Perimetry (Visual Field Test) 1. Primary open-angle glaucoma - The most common form of glaucoma - The inner eye pressure (also called intraocular pressure or IOP) rises because the correct amount of fluid can't drain out of the eye. - The entrances to the drainage canals are clear and should be working correctly. - The clogging problem occurs further inside the drainage canals, similar to a clogged pipe below the drain in a sink Risk factors: P a g e 2|5  OPT 033: Ocular Prosthesis Treatment to lower intraocular pressure: Treatment Options: A. Topical drugs 1. Steroids- manage uveitis B. Laser therapy 2. Antibiotics- treat infection C. Surgical intervention 3. Immunosuppressing medications- autoimmune condition 4. Eye surgery- for more advanced cases of eye Damage A. Topical drugs 5. Reattachment of the retina to the choroid for retinal detachment - Current medical therapy for primary open-angle glaucoma is limited toward lowering 6. Prosthetic eye: In total end-stage eye damge intraocular pressure. - A rational approach to choosing antiglaucoma medications should minimize the number VI. Anophthalmos of medications and the probability of significant adverse effects. - Absence of one or both eyes. Both the globe (human eye) and the ocular tissue are missing from the orbit. Medications used in the management of primary open-angle glaucoma include the following: - The defect occurs in utero and is congenital. a. Beta-adrenergic blockers (eg, levobunolol, timolol, carteolol, betaxolol, metipranolol, - Children with anophthalmos are born with a unilaterally small orbit and no visible ocular levobetaxolol) tissue within the orbit. b. Adrenergic agonists (eg, brimonidine, apraclonidine) c. Sess-selective sympathomimetics (eg, dipivefrin, epinephrine) d. Carbonic anhydrase inhibitors (eg, dorzolamide, brinzolamide, acetazolamide, methazolamide) e. Prostaglandin analogs (eg, latanoprost, bimatoprost, travoprost, tafluprost, latanoprostene bunod) f. Hyperosmotic agents (eg, isosorbide dinitrate, mannitol, glycerin) The absence of the eye will cause: g. Beta-blocker/alpha agonist combination (eg, brimonidine/timolol) a. Small bony orbit h. Beta-blocker/carbonic anhydrase inhibitor combination (eg,dorzolamide/timolol) b. Constricted mucosal socket i. Alpha agonist/carbonic anhydrase inhibitor (eg, brimonidine/brinzolamide) c. Short eyelids d. Reduced palpebral fissure B. Laser therapy - Laser can be used as primary or adjunctive treatment. Causes: - Objective: The objective of the surgery is to help fluids drain out of the eye, reducing a. Idiopathic(unknown)/sporadic (isolated cases) intra-ocular pressure that can cause damage to the optic nerve and loss of vision. b. Inherited as dominant c. Chromosome/Genetic abnormality d. Maternal infections during pregnancy (ie, rubella, toxoplasmosis) Management: 1. Ocular/orbital implant - A solid conformer may be placed in the orbit to stimulate bony orbital growth and to enlarge the orbital cavity in an attempt to attain normal proportions. - An ocular prosthesis may be fitted over the conformer to improve the appearance V. Phthisis bulbi - An ocular condition characterized by severe eye 2. Inflatable expander damage. Also called end-stage eye - If conformers are not tolerated or are unsuccessful, an inflatable expander may be - This condition is related to a variety of causes that lead placed surgically to scarring, inflammation, and globe disorganization. - The eyeball may look collapsed in form. 3. Eyelid surgery - In terms of eye health, phthisis bulbi is considered the - The increase in the size of a conformer is often limited by shortening of the eyelids in last stage. the palpebral fissure, which do not permit passage of a large conformer. - This means that treatment or surgery is necessary. 4. Orbital surgery Symptoms: - If conformers and expanders are unsuccessful, the bony orbit may be expanded Since phthisis bulbi is a degenerative disease, the symptoms may appear and worsen over surgically. time. - This method is preferred in cases of late referral or insufficient orbital volume a. Blurry, cloudy vision b. Floaters (dark spots that float across your eyes) The orbit can be expanded in 3 different directions, as follows: c. Light sensitivity a. Laterally d. Pain b. Inferiorly e. Redness c. Superiorly f. Swelling g. Tenderness around the eye VII. Microphthalmos h. Visual loss - A developmental disorder of the eye in which one (unilateral microphthalmia) or both (bilateral microphthalmia) eyes are Causes of phthisis bulbi may include: abnormally small and have anatomic malformations. 1. Infection - Untreated infections can lead to eye damage. 2. Chronic retinal detachment Causes: 3. Complications from surgery 1. Fetal alcohol syndrome - Some people with phthisis bulbi may have tissue damage from eye surgery that 2. Infections during pregnancy( herpes simplex virus, rubella and cytomegalovirus) develops into this condition. 3. Chromosomal abnormalities 4. Long-term inflammation. - Also called uveitis, long- term inflammation of the eye can damage related tissues. Management 5. Persistent hyperplastic primary vitreous Microphthalmia cannot be cured. However, there are treatments options to manage the - Also known as PHPV, this is a genetic condition that’s present at birth. condition and its associated symptoms - Babies born with PHPV have a malformed eye 6. Retinoblastoma 1. Prescribe glasses - This condition refers to a mass that accumulates and calcifies on the eye. - When the affected eye(s) displays some visual function, a patient's eyesight can be - Eventually, the calcification can form a tumor-like entity. It’s most common. Trusted improved (sometimes up to good state) by plus lenses, as a small eye is usually far- Source in children, and is curable. sighted - However, prompt treatment is required for full recovery. - Plus lens to enlarge the microphthalmic eye. - Trauma to the eye. Significant injuries to an eye may eventually lead to phthisis bulbi. - Even if the eye are healed from traumatic events, such as a car accident, there may 2. Use protective eye devices be lingering tissue damage that you may not be able to see. - When one of the eyes is unaffected, caution should be taken to guard the 'good' eye and - Eventually, the tissues can break down and lead to further complications. preserve its vision. P a g e 3|5  OPT 033: Ocular Prosthesis 3. Socket expansion - Do not touch, rub or try to remove any object in the eye. - allows for a better prosthetic fit later in life - If the eye has been cut or there is an object in the eye, rest a protective shield such as a paper cup on the bone around your eye. 4. Prosthetic eye - Make sure there is no pressure on the eye itself. Seek immediate, professional medical - for cosmetic reasons attention. VIII. Perforation of the cornea - Corneal perforation is an anomaly in the cornea resulting from damage to the corneal surface. - A corneal perforation means that the cornea has been penetrated, thus leaving the cornea damaged. Minor cases of trauma: (such as a black eye from a sports injury) - Applying cold to the affected area can help bring swelling down - allow the affected area Signs and symptoms to heal faster. a. vision loss b. persistent eye pain Note: Even in cases where trauma seems minor, every eye injury should be given medical c. discoloration of the cornea attention Diagnosis Prevention: Seidel test - Using protective eyewear - When engaging activities - is used to assess the presence of aqueous humor leakage from anterior chamber of the such as home repair, yard work, cleaning, cooking, and eye playing sports. - A fluorescence strip is wiped over the affected cornea. If the clear aqueous humor from - In most cases of injury, people report not properly the eye runs through the yellow stain, the patient tests positive for corneal perforation protecting their eyes – which shows that proper precautions may prevent an eye injury. TYPES OF OCULAR SURGERY IN REMOVING THE EYEBALL - Removal of an eye (enucleation), or the inside of an eye (evisceration), may be necessary for a variety of reasons. - Regardless of the underlying disorder, and whether the eye sees or not, the decision to have an eye removed can be difficult and emotionally demanding. - Skilled surgery combined with first class prosthetic care management can lead to a very acceptable aesthetic result, and in many cases the symmetry and colour match between the artificial and the fellow eye can have a very good outcome. Treatment a. Tissue adhesive - used to seal small perforation, but this method cannot be used to treat perforations larger than 1 mm. b. Non infected corneal perforation - generally heals when a pressure bandage is used c. Lamellar keratoplasty - involves selective removal and replacement of diseased corneal layers. IX. Eye Trauma/ Injury - Eye trauma refers to damage caused by a direct blow to the eye. - The trauma may affect not only the eye, but the surrounding area, including adjacent tissue and bone structure. Indications why an eye may be removed: 1. Injury 2. End stage Glaucoma 3. Retino blastoma (Cancer) 4. Micropthalmia Causes of Eye Trauma: 5. Chronic Infection inside the eye - When the eye is hit with blunt force, it suddenly compresses and retracts. 6. Eye tumors - This can cause blood to collect underneath the hit area, which leads to many of the common symptoms of eye trauma. Symptoms of Eye Trauma Pain Trouble seeing Cuts to the eyelid One eye not moving Ocular Prosthesis One eye sticks out - type of craniofacial prosthesis that replaces an absent natural eye following an enucleation, evisceration, or orbital exenteration. Blood in the clear part of the eye Unusual pupil size or shape Orbital Implant Something embedded in the eye - a permanent solid spherical implant (or ‘ball’), placed deep within the socket to Something under the eyelid that cannot be easily removed compensate for the loss of volume Management for Eye Trauma: - The muscles which move the eye are reattached to this implant. Every eye injury should be given medical attention - The superficial membranes (including the conjunctiva) are stitched over the front surface of this implant which remains permanently covered) Major cases of trauma: - The prosthesis fits over an orbital implant and under the eyelids. P a g e 4|5  OPT 033: Ocular Prosthesis Note: - artificial eye, or ‘prosthesis’ (similar to a shell) can be worn on top - once the surface III. Exenteration inflammation has settled (within a few weeks) - removal of the entire orbital contents (eye, eyelids and bony orbit) - Surgical removal of the eyeball and the surrounding tissues, these including the eyelids (the extent depending on the disease being treated), and the muscles, nerves and fatty tissue adjacent to the eye. Indication: - Large orbital tumors Types of Surgery for Removal of an eye: I. Enucleation Types of prosthetic eye II. Evisceration I. Scleral cover ocular Prosthesis III. Exenteration II. Orbital Prosthesis I. Enucleation I. Scleral cover ocular Prosthesis - A complete removal of the eyeball preserving all other orbital structure. - A specific type of ocular prosthesis that are fit and - This involves the removal of the entire eyeball (this includes the white part of the eye fabricated over the person’s existing eye. referred to as the ‘sclera’) - These prostheses cover the entire surface of a cosmetically blemished eye, restoring the eye to it’s natural appearance. Indication: 1. Endophthalmitis Primary function: - unresponsive to antibiotics 1. To replace the volume deficiency of the smaller than normal eye 2. Painful eyes with no useful vision - Without prosthetic restoration, the inadequate volume of the eye will result in a lack of 3. Malignant intraocular tumors eyelid support. 4. Phthisis bulbi with degeneration Lack of eyelid support will result to: 1. Narrowing of the eyelid opening 2. Superior eyelid ptosis Benefits & Advantage of Scleral cover ocular Prosthesis: 1. Prevent surgical disruption (evisceration or enucleation) of the orbital contents. 2. Prevent a pseudo blepharoptosis (sagging upper eyelid) caused by global volume loss (phthisis) 3. Reduce ectropion by providing support to a prolapsed lower eyelid 4. Prosthetic eye moves together with the other eye 5. More affordable II. Orbital Prosthesis II. Evisceration - A type of customized ocular prosthesis that replaces - complete removal of the contents of the eye (cornea, iris, crystalline lens, retina) with removed facial structure due to condition such as large retention of the sclera and EOM. eye tumor via exenteration. - The sclera is not removed, but used as a natural wrapping material to cover the ball - An orbital prosthesis restores the appearance of implant. eyeball and eyelids and may include the eyebrow and - This operation is easier to perform but cannot be undertaken for patients who have an part of the forehead, nose, or cheek. eye tumour. Primary function of orbital prosthesis: Advantage: - Serves as a major morale booster in these patients by combating the physical and a. Easier to perform emotional trauma. b. Fast recovery for the patient Advantage: Indication: 1. Symmetrical facial structure a. Endophthalmitis b. Ocular Trauma Disadvantage: c. Corneal ulcer 1. Eye does not move together with the other eye when d. Panophthalmitis looking up and down, side to side. e. Improvement of cosmetics in the blind eye 2. Asymmetrical facial expression - Since the eye changes with changing expressions, the orbital prosthesis will never be perfectly symmetrical 100% of the time 3. Expensive P a g e 5|5