The Eye Guy

How to handle total failure in ophthalmology

“Total failure” for ophthalmologists is when an eye has been totally lost. There is no vision and the eyeball must be surgically removed. This may be as a result of an injury or disease. When an injury destroys the integrity of the eye or disease causes intractable pain, the eye may have to be removed surgically. Other conditions that require removal of an eye may be tumors (such as choroidal melanoma or a chronically painful blind eye in adults) or retinoblastoma in children).

What next? When an eye is removed the space must be filled. The goal is to end up with a cosmetically excellent situation whereby no one would notice that the patient has had an enucleation (surgical removal of the eye). This should be the rule, rather than the exception.

How is this done? When the eye must be removed surgically, the empty socket is “filled” by implantation of one of several types of balls to fill the space which was occupied by the eye. Then a prosthesis (artificial eye) is placed in between the lids. The cosmetic appearance depends upon the size of the ball and of the prosthesis which will then be painted to match the “good” eye. This requires the skills of an ocularist who will make the prostheis. A mold is made to fill the space between the lids. A goal is to have this mold move in synchrony with the healthy eye. The mold is then painted so that it matches the healthy eye.  When it fits and moves correctly (hopefully in synchrony with the healthy eye), it is often not noticeable to others.

When one has a prosthesis, periodic care is necessary. This involves periodic removal and cleansing of the socket and regular polishing of the surface. Occasionally it may require replacement. In children the prosthesis may have to be replaced periodically as the child grows older.
                                                                                                        
Especially important for anyone who only has vision in one eye is the protection of the good eye. The best protection is to wear polycarbonate safety glasses to avoid injuring the remaining eye. This is recommended even if one has excellent vision without glasses. In addition regular (at least annual) eye examinations are essential to keep the remaining eye healthy. We want to diagnose eye disease as early as possible to prevent one-eyed individuals to lead as normal a life as possible.
 
One often wonders about what disability occurs when an eye is lost. Actually, a one-eyed individual can usually do almost everything that a two-eye person can. There are some difficulties judging distance, which is overcome over a period of time. There is almost nothing that a one-eyed person cannot do. Occupations that require two-eye binocular vision may be pilots, law enforcement individuals and some areas in which fine binocular vision is required. Driving, working and a normal life are possible.

Although this might not affect the individual reader, if you know someone who has had a major injury, let him or her know that help is available. Help is divided between the ophthalmologist and the ocularist. The ocularist is a professional who fits, makes and maintains the prosthetic eyes.

Frank J. Weinstock, MD,FACS is a Professor of Ophthalmology- NEOUCOM, and an Affiliate Clinical Professor at Florida Atlantic University. He lives in Boca Raton and Canton, Ohio

©2008 Frank Weinstock.