Prosthetic Eye Surgery
and Treatment

The concerns of
those who have
a prosthetic eye

Specifically, the two main problems for people with prosthetic eyes are (1) Upper Eyelid Depression and (2) Lower Eyelid Ptosis and Inverted Eyelashes.

About prosthetic eye problems
that are actually caused by the same

1. Upper Eyelid Depression

2. Lower Eyelid Ptosis
   and Inverted Eyelashes

These are actually caused by the same cause. The cause is a lack of volume in the orbit (space around the eye).
If a person has to wear a prosthetic eye, the eye must have reduced or lost its function.
Such an eyeball has been reduced in size or, in some cases, removed, resulting in the absence of the eyeball.
When the volume of the eyeball is reduced or removed, the entire orbit is depressed, especially in the upper eyelid, and this is manifested as a concavity.

Why is
a prosthetic table necessary
for prosthetic eye care?

Normal condition

The upper eyelid is normal with no concavity.

No prosthetic base, depressed upper eyelid

When the volume of the eyeball is reduced or removed, the entire orbit is depressed, especially in the upper eyelid, and this is manifested as a concavity of the eyelid.

To correct the concavity of the upper eyelid,
a thicker prosthetic eye is made...

Prosthetists try to fix an upper eyelid dent by making the upper part of the prosthesis thicker to fix the upper eyelid dent or to fix a drooping eyelid. In fact, making the upper part of the prosthesis thicker increases pressure in the upward direction, but it also increases pressure in the downward direction.

In other words, the thickened prosthesis not only pushes the upper eyelid up, but also pushes the lower eyelid down as a side effect.
This causes the second condition, lower eyelid ptosis (lower eyelid drooping) and inverted eyelashes.
The conjunctiva (white eye) of the lower eyelid is pushed down by the prosthetic eye, resulting in inverted eyelashes that turn inward. This occurs because the prosthesis is enlarged to accommodate the decreased volume of the eyeball.
This happens because the prosthetic eye is enlarged to accommodate the reduced volume of the eyeball.

下まぶたが下がった際の 治療方法について

So, if the lower eyelid is going to be like this, how can it be addressed?
The answer is to increase the orbital volume and make the prosthesis as thin as possible.
By making the prosthesis as thin as possible, the pressure on the lower eyelid can be reduced.
But this will of course make the indentation of the upper eyelid worse.
What is needed, therefore, is to increase the orbital volume in the first place.
It is necessary to compensate for the loss or reduction of the orbital volume.
To increase the orbital volume, something must be placed in the orbit.
In some cases, a part of the patient's own body, such as fat from the groin or rib cartilage, may be inserted, but this requires a longer operation time, causes damage to the body, and has an indefinite effect.

Two treatment options we offer

1. Hyaluronic Acid

   The first is hyaluronic acid. Hyaluronic acid, used primarily for cosmetic purposes, can be injected easily and remains in the body for a relatively long period of time, making it an easy treatment.
   However, it cannot be injected in large quantities, its effectiveness has not been proven, and it is gradually absorbed, so it is recommended that it be combined with other materials.

2. Prosthetic Table

   The second is a biocompatible artificial material such as acrylic or hydroxyapatite as a prosthetic base. Unlike hyaluronic acid, the prosthetic base itself has a reasonable volume, so once it is inserted, it can provide a reasonable volume by itself.

The prosthetic eye is about half as thin with the prosthetic eye stand.

The volume of the eyeball is about 7㏄.
However, an 18mm-diameter prosthetic eye base has a volume of 3.1㏄ and a 20mm-diameter prosthetic eye base has a volume of 4.2㏄, so if these prosthetic eye bases can be inserted, the volume of the prosthetic eye is only 2-3㏄, which is about half as thin. This means that the volume of the prosthesis can be reduced by about half.

Problems with the prosthetic table so far

However, there is a problem with this prosthetic eye stand. In fact, there is no approved material for the prosthetic eye stand in Japan.
Even if there is no government-approved material, it is possible for doctors to use unapproved materials at their discretion, so in the past, all medical institutions used to insert balls made of acrylic or other materials that were not approved by the government as prosthetic eye stands.
However, today, such unapproved materials are no longer available at all at larger medical institutions.
When this happens, it is the patients who are in trouble. As mentioned earlier, if the prosthetic eye stand cannot be inserted, the only option is to enlarge the prosthetic eye, and this has led to a number of patients suffering from inverted eyelashes and droopy lower eyelids.

We use a biocompatible prosthetic table

In order to respond to these circumstances, our clinic has been importing prosthetic eye stands approved overseas for implantation in the orbit, and we have been inserting balls made of acrylic and other materials as we have in the past.
Unlike acrylic balls, the prosthetic eye implantation table used in other countries has fine holes that allow for easy attachment to the tissue of the orbit and is said to be resistant to bacterial infection.
We can provide treatment at our own expense or with insurance, so we would be happy to consult with you.

Post-treatment

The prosthetic eye can be made thinner by inserting a prosthetic base.
The thinner the prosthetic eye, the closer to its natural shape it becomes.
Other treatments such as eyelid drooping and inverted eyelids can also be combined to reduce the difference between the normal eye and the prosthetic eye.

Flow of Prosthetic Eye Treatment

1. Visit to a clinic

2. Preparation for surgery

3. Anesthetic injection (sedation)

4. Surgery

5. Recovery from anesthesia (sedation)

6. Leaving hospital

Prosthetic eye cases

Case1.

Before

After

Case2.

Before

After

Case3.

Before

After

Post-treatment follow-up

After the surgery, the patient is revisited about 1~2 weeks later. After that, revisit 3 months later to complete the process.

義眼師について

It refers to a person who makes artificial eyes, but unlike doctors, nurses, etc., it is not a national qualification.

Recommended optometrist

Atsusawa prosthesis

Japan Prosthetic Eye Institute