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Ocular prosthesis


Key points

  • Definition: An ocular prosthesis (OP) is a device that replaces the native eye after enucleation, evisceration, or exenteration.

  • Also known as: glass eye, artificial eye.

  • Classic clue: The patient usually visits the radiology department for neuro computed tomography (CT) or magnetic resonance imaging for a problem totally unrelated to the OP and the device is first found by an unsuspecting resident or fellow with no pertinent history to suggest its origin.

  • The prosthesis fits under the eyelid and over any orbital implant.

Imaging

  • The patient and at least one of the clinicians generally know that the patient has an OP, but not necessarily the clinician(s) caring for the patient at the time of the current imaging study.

  • The patient and the clinicians generally know why the patient has the OP, but again this information may not be available in the emergency department of a hospital other than the hospital where the patient’s records are held.

  • It is helpful if the radiologist can shed some light on the situation. For example, Figure 9-4 shows a patient who has an OP and a prior medial blowout orbital fracture suggesting that the etiology was posttraumatic.

    FIGURE 9-5 ■, Enucleation with placement of an orbital implant. The orbital implant is sutured within the intraconal space (arrow) . The layered closure includes the rectus muscles, Tenon’s capsule, and the conjunctiva. A custom-fit ocular prosthesis is worn on the ocular surface (arrowhead) .

  • It is most helpful if the radiologist has some understanding of the reasons for the OP and the types of prostheses used over the last few decades, given that patients may have acquired their OP at any point.

Computed tomography features

  • High-attenuation OPs are easily exposed on CT and plain films (see Figures 9-1 and 9-2 , B ).

    FIGURE 9-1 ■, Anteroposterior and lateral radiographs clearly showing opaque, spherical aluminum oxide orbital prosthesis OD (right eye).

    FIGURE 9-2 ■, A, Sagittal T1 magnetic resonance imaging showing low-signal implant and orbital prosthesis (OP) compared with orbital fat. B, Axial computed tomography showing high-attenuation, spherical orbital implant with overlying OP comprising low-attenuation plastic base and pupil with higher-density acrylic scleral surface.

  • Low-attenuation plastic components are less conspicuous when observed adjacent to orbital fat (see Figures 9-1 and 9-2 , B ).

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