Patient information — Artificial eyes and orbital implants

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Before surgery

If you are taking regular medication, you may need to stop three weeks before surgery, so ask your doctor or Mr Malhotra. Some medications can cause excessive bleeding.

As your operation will take place under a general anaesthetic, you may have some blood tests and an ECG (heart tracing) before surgery. Please bring all your tablets/medications in their original, labelled bottles and give information on any known allergies.

It is important that you follow instructions about food and drink before surgery. If your operation is scheduled for the morning, do not eat or drink anything after 12 midnight the previous night – do not have breakfast. If your operation is scheduled for the afternoon, have an early, light breakfast – do not eat or drink anything after 7.30 am.

After surgery

Your usual medications may be continued. Resume aspirin, blood thinners, and arthritis medications 72 hours after surgery, unless otherwise instructed.

You may experience difficulty wearing your glasses because of the dressings.

In some cases, a graft will have been taken from your lower lip, generally in a separate procedure, to increase the amount of moist inner lining of the eyelid. If this applies to you, use Chlorhexidine mouthwash four to five times a day and eat a soft diet. Avoid hot drinks for at least two weeks.

You will be given antibiotics, usually Augmentin 375mg, three times a day (or Erythromycin if you are allergic to Penicillin) for seven days. Complete the course and do not omit a dose.

You may also be given a two-week course of anti-inflammatory tablets – Diclofenac 50mg – which should be taken three times a day. You should not take these if you have a history of ulcer problems or if you experience heartburn. These should be taken with food. They also act as a painkiller.

Apply antibiotic ointment three times a day to the edges of the eyelids and the inner moist lining of the eyelids (the socket) for two weeks after the dressings have been removed. Use sterile cotton wool balls and saline to keep the eyelids clean of any discharge two or three times a day. You will substitute antibiotic eye drops as soon as the temporary stitch has been removed.

The stitches used to close the wound in the socket are absorbable and will drop out in three to four weeks.

It may be necessary to remove and clean your conformer. You will be shown how to do this.

Looking after an artificial eye

Keep your artificial eye clean at all times. The first few times you clean your eye you will probably be a bit nervous – most people are. You will soon find out that you are able to do it simply and comfortably.

If you have any problems looking after your eye, please get in touch with Mr Malhotra and his team.

It is normal to have a certain amount of discharge in your socket. This varies from person to person. It can be worse in very cold weather, for instance, or if you are not well. You can also get a build up of dirt or dust in your socket. If you work in a dirty or dusty atmosphere you are likely to suffer more discharge than someone who works in a cleaner atmosphere.

There are no set rules about how often you clean your eye. If you have a lot of discharge from your socket, you may need to clean it several times a day. For most people, once a day is about right. Mr Malhotra recommends that the eye is removed for cleaning at least once every 30 days.

Taking out your artificial eye is very simple. Take your time and follow these simple steps:

• Wash and dry your hands
• Look into a mirror
• Put something soft like a towel in the wash basin or on the table in front of you – if your eye drops out, it will have a soft landing. Be careful that it does not drop onto the floor. It could get scratched or chipped if it falls onto a hard surface.
• Gently pull your lower lid down until you can see the lower edge of your artificial eye.
• Put the thin end of the extractor between your lower lid and the lower edge of the eye.
• Lever the eye gently forward over the lid.

Like this (courtesy of the National Artificial Eye Service):

When you do this, your eye will usually fall out into your hand or drop onto the towel.

Cleaning the eye is also very simple:

• Use wet cotton wool to clean away any discharge on your eyelids or your eyelashes.
• Use an eye bath with a simple saline solution to wash out your socket. The easiest way to make up a saline solution is to dissolve one teaspoonful of salt in a pint of boiling water and then let it cool.
• Use warm water and mild, non-scented soap to wash your artificial eye. Rub the eye gently with your fingers but make sure you do not scratch or drop it.
• Rinse the eye thoroughly using sterile water before you refit it. Make sure you rinse all the soap off. If you do not, it will irritate and hurt your socket when you refit your eye.
• Never use chemical cleaners, disinfectants or detergents to clean your artificial eye – they can cause permanent damage to the surface.

To refit your eye:

• Lift your upper lid with one hand to make room for your artificial eye.
• Hold your artificial eye in the other hand. Make sure you have the eye the right way round. Usually the most pointed end fits nearest your nose.
• Push your eye gently under your top lid until it reaches the top of your socket.

Like this:

• Hold the eye in that position with one finger of the hand you are using to hold your upper lid. This stops the eye falling out.
• Using your free hand, gently pull down your lower lid. The bottom of your eye will slip inside.

Like this:

As long as your eye is comfortable, you can wear it all the time but you must take it out and clean it regularly. If you would rather take your eye out when you go to bed, make sure you keep it in a container of sterile water or the same sort of saline solution as your use to clean your socket.

Do not worry if these instructions seem complicated at first. If you have any problems, or if you are not sure about something, please get in touch with Mr Malhotra and his team. If you need more extractors for taking your eye out, just let us know.

Check-ups

You will sometimes need to come to the clinic so that the prosthetist can check and polish your eye, check the condition of your eye and socket and tell you about replacement eyes. Sockets, artificial eyes and your own eye can change over time and we will only know if you need any changes if you attend regularly.

After you have worn your eye for some time, it will start to feel gritty and uncomfortable, or you may notice that there is more discharge. This is quite normal and is caused by ordinary wear and tear.

When this happens you should have your eye checked and polished. As a general guide, we advise you to have a routine check and polish every 12 months, but you can have one more often if you need it.

It is very important to have your eye checked and polished as often as necessary, or you may suffer unnecessary discomfort.

If you get an infection in your socket you should see your own doctor. Infections like this usually clear up quite easily with drops or ointment.

If you have any problems at all looking after your eye, please call your prosthetist. You may also call the NHS National Artificial Eye Service helpline on 0845 6050561.

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