These can be made of glass or plastic molded to the shape of the eye socket and painted to match the other eye. Usually they are removed and washed at night by the patient and replaced the following morning. A slight degree of discharge from the socket is the rule but excessive discharge can indicate that the socket is becoming infected. This, in turn, might be because of roughening of the artificial eye with wear. Under these circumstances, arrangements should be made for the prosthesis to be replaced or polished. It should always be borne in mind that a patient with an artificial eye might have had the eye removed because it contained a malignant tumour, in which case one must consider the possibility of local or systemic spread of the tumour. A well-made artificial eye is almost undetectable to the untrained eye but normal movements of the eye can be restricted. Nowadays, the use of orbital prostheses deep to the conjunctiva and attached to the eye muscles gives greatly increased movement. After many years and after renewing the artificial eye on several occasions,the eye can appear to sink downwards.
Surgical removal of an eye (enucleation) is considered in the following circumstances:
• when the eye is blind and painful
• when the eye contains a malignant tumour
• when the eye is nearly blind and sympathetic ophthalmitis is a risk following a perforating injury.
Before having an eye removed, the patient must be made fully aware of all the advantages and disadvantages. A general anaesthetic is needed and the patient remains in hospital for one to two nights after the operation. It is common practice to fit the socket with a transparent plastic "shell" for a few weeks until the artificial eye is fitted.
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