By Dr. Dyonne Hartong
Notable signs of a volume deficit include a lower-set upper eyelid and an eye that sits lower than on the other side. The causes of volume loss can vary.
Causes of Volume Loss
For example, the combination of the implant and the prosthesis volume may be insufficient. Or there may be (local) loss of fat volume due to trauma/scarring, inflammation, or radiation therapy. Sometimes there is insufficient mucosa, which means the ocularist can only fit a small prosthesis. A fractured eye socket can also cause the tissues to sag further backward. A drooping eyelid can sometimes give the impression of a volume deficiency, but this usually improves once the drooping eyelid is corrected.
Prosthetic Adjustments
The best solution for improving volume will therefore depend on the underlying problem, but also on the wishes of the prosthesis wearer. In virtually all situations, it is important for the ocularist to first assess whether adjustments can be made to the prosthesis. This is because, during the first year after surgery and as a person ages, there is a natural decrease in the volume of the eye socket. This decrease can usually be addressed by adjusting the size of the prosthesis. If further adjustments are not possible, or if irritation occurs due to an eye prosthesis that is too large, we can explore other options.
Filler Injections
At Amsterdam UMC, we began using fillers several years ago to restore volume lost due to prosthetics. We currently use this method most often because it is a very minor procedure that produces immediate results and carries little risk of changes to the eye socket. The filler consists of hyaluronic acid, a natural substance that is biodegradable. However, in practice, we observe that the added volume often persists for many years. Surveys also show that prosthesis wearers are more satisfied with the appearance of their eye following a filler injection. These findings were recently presented at the conference of the Dutch Ophthalmological Society (NOG). The improvements in volume and symmetry can also be clearly measured on the 3D facial scans. The researchers are currently analyzing the latest data from these scans for a scientific publication on this treatment.
Autologous filler or plate
There are also alternatives to synthetic fillers, namely using the body’s own fat harvested from the abdomen or thighs. However, fat can also diminish over time. No comparative studies have yet been conducted between synthetic and autologous fillers. Reducing the size of the eye socket by placing a plate on the floor of the eye socket also increases volume. The advantage of this is that it provides a fixed volume. A disadvantage of using a plate, however, is that it can reduce the mobility of the prosthesis.
Even more possibilities
If there is a lack of mucosa, greater volume can be achieved by placing a mucosal graft or a fat graft in the eye socket. Afterward, a better-fitting prosthesis can be made. And sometimes it may be advisable to replace the existing (or perhaps absent) implant with a larger implant or a buttock fat graft.
Custom Solutions
Conclusion: There are, therefore, several options for treating a volume deficiency in a prosthetic eye. Each procedure has its own risks, advantages, and disadvantages. In a large number of cases, we can achieve a noticeable improvement with a relatively minor procedure (such as a filler). You can discuss the options available to you with your orbital specialist.
