Q: I have a patient who has a prosthetic eye. I’ve never had to deal with this before. What kind of care does a prosthetic eye require? Who do I comanage this patient with?

A: Just because the patient is without an eye doesn’t mean he won’t need your help, says David B. Herndon, B.C.O., B.A.D.O., an ocularist at Atlanta Eye Prosthetics, in Sandy Springs, Ga. For instance, a patient with a prosthetic eye will need to see an optometrist for ongoing medical care of the remaining eye, as well as optical services.

Optical Services
“One of the greatest services an optometrist can provide for these patients is in cosmetic optics,” Mr. Herndon says. “Glasses are good camouflage for the prosthetic eye wearer.”

Often, the balance prescription does not achieve the best cosmesis, he says. A better choice may be a base-down prism lens over the artificial eye to elevate its appearance, which is often needed due to a stretched lower lid acquired from long years of wearing the eye.

Other lenses can compensate for a less-than-symmetrical palpebral fissure due to scarring, radiation or acid damage to the lids, Mr. Herndon adds.

“Of course, we always recommend that the patient has polycarbonate or better protective eyewear, even if correction is not needed,” he says.

Medical Eye Care
“Often a patient with a prosthetic eye presents with complaints of irritation or discomfort,” Mr. Herndon says. A frequent cause? Dry eye.

Dry eye may be present in both the socket and the intact eye. “As with other patients, dry eye can be helped with artificial tears, lubricating gel and drinking more water,” he says.

Specialized lubricants for prosthetic eyes are available, such as artificial tear gel or lubricant with a silicone base, such as Sil-Ophtho (Stony Brook Inc.). Ointment can be used for nighttime relief.

If dry eye or discomfort is left untreated, the patient can develop giant papillary conjunctivitis. This is the most likely reason an ocularist will refer the patient to the optometrist, Mr. Herndon says. The optometrist can help by prescribing a topical steroid or an antihistamine/mast cell stabilizer.

The ocularist can help by polishing the eye to remove any protein coating that the patient may react to. The patient can help by removing the prosthesis overnight.

But there are other causes for irritation and discomfort besides dry eye and GPC.

“Irritation may result from a scratched prosthesis,” Mr. Herndon says. “Whenever there are scratches or a build-up of mucus on the surface, the prosthesis should be polished professionally.” This involves an abrasive compound and polishing lathe for the best results. Many ocularists recommend polishing every six months.

Patients should also clean the prosthesis on a monthly basis, using household soap or baby shampoo. A stubborn build-up of secretions on the surface can be removed with a soak in hydrogen peroxide or denture cleaner, Mr. Herndon says.

Discomfort is more subtle, and is likely due to an ill-fitting prosthesis. In such a case, refer the patient to an ocularist for a replacement.

So, how do you find an ocularist? “The best source for finding one locally is www.ocularist.org, which has an online, nationwide directory of Board Certified Ocularists,” Mr. Herndon says.

Optometrists and ocularists should have an open line of communication to best serve these patients. “The use of cosmetic optics to magnify, minify, elevate or alter the appearance of the prosthetic eye is extremely helpful,” Mr. Herndon says. “The optometrist as well as the ocularist should not hesitate to pick up the phone to confer on what is most appropriate in each case.”