Fabrication of Ocular Prosthesis for Phthisis Bulbi by an Innovative Impression-Less Technique - A Case Report

Abstract

Phthisis bulbi is an ocular condition caused by wound healing secondary to severe trauma, inflammation, or necrotising tumours of the eye. It represents an ocular endstage disease characterised by atrophy, shrinkage, disorganisation of the eyeball, and intraocular contents. Disfigurement associated with the eye can cause significant physical and emotional disturbance. Prosthetic rehabilitation over the residual eyeball is the preferred treatment of choice over surgical intervention such as enucleation or evisceration. Treatment of such patients is challenging and a multidisciplinary approach is required to provide a satisfactory ocular prosthesis. This case report describes the prosthetic management of a patient with phthisis bulbi by a novel impression-less technique. The initial unsaid communication that takes place between two individuals is through their “eyes”. A confident person will always maintain eye contact while conversing. They are the organs of the visual system which are sensitive to various stimuli.1 Any anomaly involving the eyes causes psychological, emotional, and aesthetic trauma to the patient. Phthisis bulbi is an ocular condition due to multifactorial conditions such as delayed wound healing secondary to severe trauma, infections such as keratitis, uveitis and endophthalmitis. Also, some failed surgical procedures including cataract, glaucoma, retinal surgery and intraocular malignancies like choroidal melanoma, retinoblastoma as well as systemic diseases like diabetes or hypertension may result in phthisis bulbi.2,3 The name “Phthisis bulbi” comes from a Greek word which means “to waste away” or “shrinkage. It is a histopathological diagnosis of end-stage non-functional ocular disease showing atrophy, shrinkage, and disorganisation of the eye and intraocular contents. Clinically, the eyes have no perception of light due to intraocular calcium deposition within band keratopathy, cataractous lens, sclera, gliotic neural retina, or within an optic nerve in the phthisical eye.4 Surgical procedures are not desired in a patient of phthisis bulbi unless it becomes painful. Hence, prosthetic rehabilitation is the only preferred treatment of choice in the patient with phthisis bulbi.5 A properly fabricated custom-made prosthesis enhances the patient's comfort, confidence, and aesthetics by increased adaptiveness, natural appearance, and functional stimulation.6 Hence, we devised an innovative approach to fabricate an ocular prosthesis for a patient suffering from phthisis bulbi by using an impression less technique which has been described in this case report.