Prosthetic eye users may encounter a range of socket problems over time. These affect both daily comfort and the appearance and fit of the prosthesis. Most can be prevented with regular care and timely review, and when they do occur they are straightforward to deal with if recognised early.
The socket is the space remaining after evisceration or enucleation, lined with conjunctiva. Its depth, the position of the lids and the volume it retains all determine how the prosthesis will sit.
The orbital implant placed at surgery provides most of the volume. The prosthesis is a thin shell that sits in front of the implant, behind the eyelids. Socket, lids and prosthesis form a connected balance, and a change in one affects the others. For the operations themselves see the evisceration and enucleation page.
Socket problems can largely be prevented with regular care and specialist review. If you feel any discomfort, it is worth having it assessed rather than waiting. For prosthesis care and replacement intervals, see the prosthetic eye page.
Ayşe Dolar Bilge MD, FEBOphth.
Ophthalmologist, Oculoplastic Surgery
As an Ophthalmologist, Dr. Ayşe Dolar Bilge, I provide diagnosis and treatment services with my experienced team.
The most common reason is the surface of the prosthesis becoming dull with deposits building up on it; polishing usually resolves this. Reduced tear production or poor tear quality also makes the socket produce heavy mucus in response. A prosthesis that no longer fits, inflammation of the lid margin and lapses in the cleaning routine are other causes. Discharge that turns yellow or green, with pain, should be assessed.
Wash your hands with soap and work over a sink with a towel laid underneath. Rinse the prosthesis with lukewarm water; if an oily film remains, wash it with a neutral, unscented soap and rinse thoroughly. Do not use alcohol, cologne, bleach, toothpaste or stiff brushes, as these damage the polished surface. Do not rub the socket; wipe crusting from the lid margin with moistened clean cotton, from the inner corner outwards.
Acrylic prostheses wear down over the years: the surface becomes scratched and the paint fades. In adults, replacement roughly every four to six years with polishing in between is usually appropriate. Because socket volume changes over time, the thickness may also need adjusting. In children, replacement is needed far more often as the facial bones grow. I recommend a socket and prosthesis check once a year.
The most common reasons are a prosthesis that no longer fits the socket, a lax lower lid that cannot support it, and shallowing of the fornices. A worn prosthesis whose edges have lost their shape also holds less well. The fit of the prosthesis, the position of the lids and the depth of the socket are assessed together. The answer is sometimes a new prosthesis and sometimes surgical correction of lid laxity.
Socket contraction can result from insufficient conjunctiva, scar tissue, previous radiotherapy or severe trauma. The most common preventable cause is leaving the socket empty for long periods; once the prosthesis or conformer is removed, the socket begins to shrink quickly. The prosthesis should therefore stay in place continuously. In advanced contraction, mucous membrane or tissue grafts can be used to deepen the fornices.
Increasing redness, swelling, warmth, persistent pain and dark-coloured or foul-smelling discharge suggest infection. Bleeding from the socket also needs assessment. With these signs, do not force the prosthesis in or out, and seek advice without delay. A whitish area appearing in the socket may indicate that the tissue over the implant has opened, which should also be assessed promptly.
Hollowing of the upper lid results from volume loss in the socket over time and is part of anophthalmic socket syndrome. Where the loss is mild, building up the back surface of the prosthesis can compensate. In more marked cases, adding volume to the socket or surgically correcting accompanying lid droop is considered. The appropriate method is chosen by assessing socket depth and lid position together.
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