Divestiture
In rare cases (1–4%), the synthetic implant may come out again. We call this rejection. This is more common in people who have had a severe infection. If the implant is rejected, we can restore the volume using fat from the buttock. This usually works well, although it does leave a scar on the buttock. If only a small part of the implant is visible, we cover it with a thin layer of donor sclera. This allows us to resolve symptoms related to the eye socket and helps prevent total rejection.
Pain or irritation in the eye socket
Sometimes, after surgery, people experience pain or discomfort in the eye socket. This may be caused by the prosthesis, inflammation, an infection, or nerve pain. For example, a prosthesis may develop scratches or put pressure on certain areas. This causes it to rub against the mucous membrane, leading to irritation. Polishing or replacing the prosthesis often helps in such cases. Other causes of pain, such as inflammation or an infection in the eye socket, can be diagnosed and treated by an ophthalmologist. Sometimes you may experience nerve pain. This is pain that is not caused by the surgery itself, but by previous damage to the nerves. This pain can be very unpleasant, but fortunately, a pain specialist can evaluate it and help reduce the pain.
Lumps or swellings
Sometimes swelling or small lumps can also develop in the eye socket. This is caused, for example, by an inflammatory reaction, which leads to the formation of a granuloma. This usually goes away on its own, but sometimes eye drops help it clear up faster, or we surgically remove it. The cause is often that the artificial eye does not fit properly.
Cysts may also develop. These are fluid-filled sacs. They form when the mucous membrane grows inward. Sometimes they remain small and do not cause any symptoms. But if they grow larger, the artificial eye will no longer fit properly. In that case, surgery is needed to remove the cyst.
Mucus or fluid
Each eye socket contains a mucous membrane, just like the mouth. This mucous membrane produces fluid to keep the (artificial) eye moist. Irritation leading to increased fluid production can be caused, for example, by a poorly fitting artificial eye or by removing and reinserting the prosthesis too often. We know that a thin layer, known as a biofilm, forms on the artificial eye when you leave it in for a while. If you clean the eye frequently or keep removing it, that layer becomes unbalanced, which can lead to more symptoms. For most people, cleaning once a month is ideal, but some people respond better to more frequent cleaning. Try waiting a little longer between cleanings if you’re experiencing a lot of discomfort.
Sometimes mucus also leaks out due to a buildup behind the artificial eye, in what is known as the “dead space.” This creates a cavity where fluid accumulates, and it can suddenly leak out. In such cases, a new prosthesis that fits the eye socket more snugly can help. The ocularist can also make a small hole in the prosthesis to allow the fluid to drain more easily.
Cosmetic concerns
After an eye removal, the face may look different. For example, this could be due to a drooping upper or lower eyelid, or because the artificial eye sits deeper in the eye socket. A dark shadow may also appear above the eye.
Drooping Upper Eyelid (ptosis)
A drooping upper eyelid can be caused by the prosthesis stretching the eyelid. However, sometimes the prosthesis is actually too small. In that case, it does not provide adequate support for the eyelid. The ocularist can adjust the prosthesis, but if that does not help, surgery may be necessary.
Lower eyelid drooping (ectropion)
The lower eyelidmay begin to droop, especially if the prosthesis is heavy. This occurs more frequently in people without an implant. With a minor surgical procedure, we can often restore proper closure of the lower eyelid.
Insufficient volume around the eye
Sometimes it may appear as though the artificial eye sits deeper in the eye socket or is slightly crooked. This is because there is less volume around the eye. As a result, a dark shadow may also form above the eye. The skin sags slightly more in that area, especially if the other eyelid is still full and firm. This difference then becomes even more noticeable. A larger prosthesis is sometimes a solution, but not always. If that doesn’t help enough, we explore other options. This could be a simple treatment, such as a filler injection to restore volume. Sometimes a minor correction to the other eyelid is more effective, to restore balance. And in some cases, a more extensive surgery is necessary. The best approach varies from person to person. The orbital surgeon will develop a customized plan, carefully evaluating the eye socket, the skin, the patient’s medical history, and the potential risks.
The prosthesis no longer fits or falls out
For an eye prosthesis to fit properly, there must be sufficient space in the grooves beneath the upper and lower eyelids (the fornices). Sometimes these spaces become smaller due to scarring of the mucous membrane. As a result, the prosthesis no longer fits properly or may even fall out. This occurs more frequently in people who have undergone multiple surgeries or radiation therapy. In cases of mild scarring, we can adjust the prosthesis. In cases of severe scarring, surgery is sometimes necessary, during which we use mucous membrane from the mouth to restore the eye socket.
Eye drops for persistent symptoms
If all technical adjustments to the prosthesis have been made but certain symptoms persist, using eye drops or ointment may help.
Collaboration Between an Ocularist and an Ophthalmologist
Dr. Hartong: “Fortunately, most problems—whether major or minor—can be resolved after an eye removal. Through close collaboration between the ophthalmologist and the ocularist, we hope to contribute to a good quality of life after an eye removal.”
