Understanding
the Artificial Eye
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There is a fascinating history surrounding the artificial
eye and its development. During Egypt's ancient times,
bronze and precious gems were placed upon the eyes of dead
people of means and importance. Artificial eyes were also
made of painted clay attached to cloth and placed over the
socket. Romans decorated statuary with silver artificial
eyes. During the years of the 1500s the first description of
an artificial eye prepared to fit an eye socket was revealed
by Ambrose Pare, a well known French surgeon. They were made
of gold or silver. One style was worn in front or under the
eyelids. Enucleation was not a very popular procedure until
much later so that the artificial eye was not implanted in
the eye socket but placed directly over the blind eye. |
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A few decades ago, many eye care providers were
occasionally called upon to render a service to patients who
experienced enucleation. Today, they are few and far
between. The specialists who fit, design and make prosthetic
eyes are called "ocularists." At present, improved
surgical procedures, preventative eye care techniques and
improved safety measures in the industry account for a
reduced number of eye removals.
Joseph LeGrand Jr. is a prominent ocularist in
charge of a firm that was started by his father in 1953. He
explained to me that independent fitters are sought by
surgeons and patients since they demand service from
well-educated and trained personnel. The ocularists are a
well organized, cohesive group and have not surrendered to
external influences or control. The American Society of
Ocularists has been the focal point for their group activity
and is well supported. Some eye care professionals might
find a valuable lesson in this.
The background regarding creation of the modern era
artificial eye is most interesting. Prostheses made of
enamel (1820-1890) were not very durable but somewhat
more attractive than those which preceded it. German and
Venetian technicians were credited with inventing a formula
for making a type of glass whose color was easily adapted
for glass eye use. A tube of this special glass was heated
at one end until a molten ball was produced and glass
blowing skill was applied to achieve the desired effect.
Various colors of glass were used in combination to imitate
the colors of the eye to be matched. The process of creating
artificial eyes was handed down as family secrets from one
generation to the next.
Germany records a special history of fabricating doll
eyes, Christmas ornaments and prosthetic eyes. German
craftsmen were so well advanced in this field that they were
the first to be designated professionally as "ocularists."
These gifted artisans began to tour the United States and
other areas throughout the world. Once anchored in a
location they proceeded to fabricate eyes and fit them to
the patients in that particular area. They also fitted
artificial eyes by mail order. Hundreds of pre-made eyes
might be kept in stock so patients could be fitted right out
of the drawer. The fitters were often referred to as
"eye doctors."
In the 1850s several German founded companies made
artificial eyes in New York City and sold eyes to local
practitioners. Sometimes they would supply semi finished
custom eyes to individuals. United States fitters continued
to use glass for the artificial eyes until World War II.
German imports were limited and German glass blowers were no
longer touring the U.S. The U.S. army and national
fabricators along with private practitioners began using
acrylic plastic polymers and oil pigments. These basic
concepts, with accrued improvements, have become the best
choices for developments in the ocular prosthesis field.
Plastic eyes are molded by the ocularist to provide the
best cosmetic effect and excellence of comfort and fit. If
the patient complies with the instructions regarding care
and cleaning, it is possible for the artificial eye to last
as long as a decade. However, Mr. LeGrand informed me that
the average life is 5-7 years based on possible cosmetic
changes. The muscles and other tissues in the eye socket
will adapt to the post operative circumstances. New
developments with artificial eyes allow them to be left in
place as much as possible. This includes sleep schedules.
Some patients remove the eye for cleaning every few weeks.
Others perform this task only every few months with no
adverse results.
An ocular implant replaces the removed tissue of the eye.
The first record of an implant was in 1841. They have been
made of many different materials, shapes and types over the
years. They are made to aid the artificial eye to have some
degree of natural movement. The surgeon, following the
enucleation procedure, will attach the remaining musculature
to the implant. Mr. Legrand reports, "Porous implants
made from coral, newly developed plastics or other materials
were introduced around 1987. They generally provide superior
motility with fewer complications when compared to early
plastics or glass spheres."
This allows the muscles to move the artificial eye in a
manner that is similar to the action of a normal eye. The
reader will be surprised to know that the new eye is not
rounded in shape as you would expect in comparison with your
normal eye. It is shaped, more or less, like a bottle cap
and is fitted over the implant. The fitting and dispensing
of the artificial eye may take only one day. However,
depending on the ocularist, it may require more than one or
two sessions. The new eye is made in several steps. While it
is not painful, it is tiring and may leave the eye socket a
bit irritated.
Once the wax impression is fashioned and finalized, the
plastic insert is made. Further adjusting and smoothing may
be necessary at this stage of the fitting. The
ocularist is attempting to mold the impression in such a way
that the eyelids will rest properly when the eye is open or
closed. He merely removes it, adjusts it and reinserts it.
Some ocularists use a special lubrication to help prevent
the irritation that is sometimes caused by frequent removals
and insertions of the impression. The ocularist will
then draw a sketch on this implant to determine how the eye
hole should be aligned. He will drill a hole in the material
to meet the necessary alignment measurement. He will insert
the colored area of the artificial eye via a "button”
that closely resembles the alternate eye. This is placed
over and around the implant in preparation for the painting
process. The small red blood vessels may be copied by
attaching small strands of fabric on the plastic. In the
hands of an expert the new eye should be a close match to
the remaining eye.
The patient must understand that as a result of losing
the eye, the orbital tissues and muscles recede and change.
The change is very profound from the first to the sixth week
and no attempt should be made for a fitting before that
period of time. The appearance of the new eye will match the
opposite eye exactly. There are several solutions to the
expected unequal movement of the artificial eye. Sunglasses
or mildly tinted eyewear can be helpful to disguise the
imbalance of movement. Recently reported developments
regarding digitalized coloring of the artificial eye may
help substantially in the manufacturing process, although
Mr. Legrand does not endorse digitalized coloring since the
long term results are not known at this time.
The vanguard of ocularists is discovering how to use
modern approaches to advance their profession and intend to
ride the crest of the wave into the future. Eye care
providers everywhere will wish them the best in their
endeavors on behalf of the monocular public.
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