Response of the anophthalmic socket to prosthetic eye wear

Abstract

A regular complaint of anophthalmic patients is excessive mucoid discharge associated with their prosthetic eyes. This problem has received little attention in the literature and no evidence-based treatment protocol has been developed to deal with it. This unsatisfactory situation has provided the motivation for the studies reported in this thesis and its two broad aims which are: to investigate mucoid discharge associated with prosthetic eye wear and to help address gaps in the literature by reporting findings that impact on current clinical practice. The thesis provides a background to the field of ocular prosthetics and describes the results of a systematic set of individual investigations that guide the research towards a greater understanding of the response of the socket to prosthetic eye wear. The data for the research was obtained from two surveys of New Zealand prosthetic eye wearers, from clinical evaluations and interventions and from in-vitro experiments. Equal interval photographic grading scales to measure conjunctival inflammation in anophthalmic sockets and the intensity and extent of deposits on prosthetic eye surfaces were developed and used for the first time in this research programme. Mucoid discharge associated with prosthetic eye wear was found to be prevalent in the anophthalmic population of New Zealand and a major concern for prosthetic eye wearers. Surface deposits accumulate on prosthetic eyes that are not cleaned frequently. The results of the investigations in this thesis showed that the presence of these deposits improved the wetting characteristics of the prosthetic eye surface and facilitated the lubricating function of socket fluids. This evidence provided a causal link for the association between more discharge and more frequent cleaning and was a key finding that led to the development of a simple three phase model of the response of the socket to prosthetic eye wear and an evidence based protocol for managing mucoid discharge. The work reported in this thesis has resulted in the preparation of six published papers and nine future research opportunities were identified.