Prosthetic Eye: Surgery, Costs and Care

6 sources cited
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What is a Prosthetic Eye?

A prosthetic eye is an artificial eye implant placed in your eye socket. The procedure is necessary if you lose your eye due to injury or disease. Most people call it a glass or fake eye.

As the name suggests, the fake eye does not have a visual function. However, it improves appearance and comfort in the eye socket.

Traditional prosthetic eyes were made of glass. Today, they are made of medical-grade plastic acrylic, which is more durable.

Although long-lasting, prosthetic eyes require cleaning from time to time (at least every 3 weeks). Cleaning and polishing may also happen during regular follow-up visits.2

What is an Ocularist?

A prosthetic eye is fitted into the ball-like implant placed in your eye socket during eye removal surgery (enucleation). Most people are ready for a prosthetic eye fitting 6 to 8 weeks after the surgery. 

An ocularist is a highly skilled professional who makes and fits ocular prostheses.1 They customize prosthetic eyes to resemble natural eyes. This includes an iris, pupil, sclera (white of the eye), and even blood vessels. 

As long as the ball implant is attached to the eye muscles, a prosthetic eye should move almost in sync with your natural eye.

How Does a Prosthetic Eye Work?

After eye removal surgery, your surgeon will place a ball-like implant to fill the space left behind. They may attach the ball implant to muscles in the eye socket to enable normal eye movement. The implant is designed to accommodate the prosthetic eye.

A prosthetic eye may not move fully like your natural eye. The pupil also does not respond to light.

2 Types of Prosthetic Eye Surgeries

There are two types of eye removal surgery: enucleation and evisceration. The main difference between the two is that one is more invasive. 

The type of surgery you need determines the type of prosthetic eye your doctor will select. Two options include: 

1. Evisceration

Evisceration is the removal of the cornea and the other contents of the eyeball. It leaves the sclera (white of the eye), eye muscles, and eyelids intact.3 

The cornea is the clear front part of your eye. Evisceration includes the placement of a ball implant to maintain the proper orbital volume.

Procedure Steps

Your surgeon will conduct initial eye exams to ensure your eyes are in good condition for the surgery. Then they will administer general anesthesia to help you sleep during the invasive procedure. They may also administer local anesthesia with sedation to ease pain and help you relax before and after surgery.

Next, they will make an incision to remove the entire cornea and other intraocular contents, including the vitreous humor, uvea tract, crystalline lens, and retina.4 Once the intraocular contents are out, your surgeon will place a ball-like implant into the shell of the sclera.

Finally, the surgeon will place a thin plastic shell (conformer) on the eye socket to maintain socket shape and reduce swelling. They may also apply a pressure bandage to reduce swelling. This procedure takes about 1 to 2 hours.

Before you’re discharged, your surgeon will check your eye to ensure everything is okay. They’ll likely prescribe pain killers (Tylenol), antibiotics, or steroids to ease pain and prevent infection. They’ll also provide you with post-operative care instructions. 

Remember to arrange for follow-up visits so your surgeon can monitor the healing process. Once you’re fully recovered (6 to 8 weeks later), your surgeon will refer you to an ocularist for prosthetic fitting. 

Side Effects/Risks

  • Headache
  • Eye pain
  • Damaged eye muscles
  • Bleeding (rare)
  • Scarring
  • Superior sulcus deformity (a sunken appearance)
  • Eye perforation
  • Eye infection
  • Socket contraction
  • Extrusion (implant falling out)
  • Exposed ball implant
  • Dislocated implant
  • Pain
  • Ptosis (drooping eyelids)
  • Ectropion (when the eyelid sags or turns outwards) 
  • Entropion (when the eyelid folds inwards, causing irritation and discomfort)
  • Enophthalmos (loss of fat within the eye socket, which causes the eye to fall back into the socket)
  • Orbital cellulitis (infection of the soft tissues behind the orbital septum)

Recovery 

You can remove the pressure bandage from your eyes a day to a week after surgery to allow for the application of antibiotics and ointments. During this time, do not rub your eyes or subject your eyes to strain. Also, do not engage in strenuous activities, including lifting objects over 10 pounds. 

Most people fully recover after about 2 months, when their prosthetic eye can be fitted into the ball implant.

Although evisceration is considered minor eye surgery, losing an eye and adjusting to life with a prosthetic eye can be overwhelming. Counseling and support groups can help you adjust. 

Cost

Evisceration is considered medically necessary and is therefore covered under medical insurance. However, even with insurance, expect to pay for specialty and hospital copays, among other costs.

Without insurance cover, evisceration costs about 2,500 to $8,000 or more. Cost will depend on your surgeon, facility location, and services available pre- and post-surgery.

2. Enucleation

Enucleation follows the same concept as evisceration but is more invasive. Your surgeon removes the entire eyeball (globe) during enucleation, only leaving the eyelids and muscles intact.

Enucleation is usually preferred over evisceration when there is significant damage to the eyeball and its contents. This is common among people with cancer, a severe injury, or an eye infection.

Your surgeon will recommend nucleation as a last resort if no other alternatives are viable.

Procedure Steps

Like in evisceration, your surgeon will administer general anesthesia and a numbing agent to prevent discomfort.5 Next, they will remove the damaged eyeball and leave the eye muscles and eyelids intact.

In the space left by the eyeball, your surgeon will place a ball implant and attach the muscles to enable movement. They will also prescribe antibiotic ointments and pain relievers to help with healing.

You’ll be ready for the prosthetic eye fitting 6 to 8 weeks after surgery. An ocularist performs prosthetic fittings.

Side Effects/Risks

The side effects of nucleation are similar to those of evisceration. You may experience headaches, eye pain, bleeding, implant dislocation, and/or infections, among other symptoms.

With proper post-op care, you can prevent or relieve side effects.

Recovery 

You will be able to return to normal activity 2 to 6 weeks after surgery, depending on the healing progress. During this time, avoid activities that strain your eyes. Wash your hands before touching your eyes to avoid infections.

Most people fully recover 6 to 8 weeks after surgery. This is the ideal time to get your prosthetic eye fitted.

Cost

Enucleation is also considered medically necessary. Your insurance should cover the procedure with a minimal out-of-pocket payment. 

Without insurance, expect to pay about $2,000 to $8,000 depending on the extent of surgery, available facilities, and your surgeon’s experience.

Talk to your surgeon and insurance provider for accurate cost estimates.

How to Care for a Prosthetic Eye 

To prevent irritation in and around your prosthetic eye and eye socket, take good care of them. Wash your prosthetic eye and eye socket if they feel inflamed or if the prosthetic is dirty.

Additional tips for caring for your prosthetic eye include:

  • Clean it with water and mild soap every 3 weeks. Never use alcohol-based cleaners.
  • After cleaning, let it air dry.6 Do not wipe with a cloth, as it may leave behind particles.
  • Wash your hands before touching your prosthetic eye. Dirty hands can introduce harmful bacteria into your eye sockets.

The materials used in a prosthetic eye (acrylic plastic) can last at least 10 years. However, due to changes that may occur in the eye socket over time, most people will need a replacement 3 to 5 years after surgery.

Call your doctor if you experience:

  • Swollen, red, and irritated eye socket
  • Cracked or chipped prosthesis
  • Problems with how your prosthetic fits 

Summary

A prosthetic eye is an artificial eye implant placed in your eye socket. The procedure is necessary if you lose your eye due to injury or disease. 

Today’s artificial eyes are made of medical-grade plastic acrylic, which is more durable than glass.

A prosthetic eye is fitted into the eye socket 6 to 8 weeks after eye removal surgery. The two types of eye removal surgery are enucleation and evisceration.

Enucleation is the complete removal of the eyeball, and it leaves the eye muscles and eyelids intact. Evisceration only removes the cornea and leaves the sclera (white of the eye), eye muscles, and eyelids intact.

Both procedures involve the placement of an artificial ball implant that holds the prosthetic eye.

Most insurance plans cover enucleation and evisceration.

6 Cited Research Articles
  1. Ocularists the less known mid eye care professionals and their contribution in eye health care,” Saudi Journal of Ophthalmology, 27 Feb. 2021
  2. When to refer to an ocularist,” American Society of Ocularists
  3. Yom K. et al.,“Enucleation and Evisceration: What to Expect,”  The University of Iowa, 29 Apr. 2020
  4.  Murchison A., “Evisceration,” American Academy of Ophthalmology, 01 Sep. 2021
  5. Lodhi O. and Tripathy K., “Anesthesia For Eye Surgery,” National Center for Biotechnology Information (NCBI), 21 Feb. 2022
  6. Caring for Your Prosthetic Eye,” Memorial Sloan Kettering Cancer Center, 12 Mar. 2020
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