Inside the Cover
 

Chapter 5

PSYCHOLOGY OF ORGAN LOSS

 

Losing an eye can be devastating, both emotionally and physically.  Whether the surgery to remove an eye was done on an emergency basis or pre-planned and performed on an elective basis, no one is ever prepared to lose an eye.  A process of grieving is necessary to lead to the eventual acceptance of losing a part of the body.  However, the extremes of avoiding grief altogether and/or excessive preoccupation with the loss can also create significant psychological disturbances.

 

As with any significant loss, such as the loss of a loved one (e.g., the death of a family member or friend), patients who have an eye removed often go through five predictable stages of grieving: denial, anger, bargaining, grief, and acceptance.  Not everyone passes through these in order, but eventually the goal is for all grieving persons to reach acceptance.  Eye doctors may only observe their patients as they experience the initial denial phase and seem to be handling life with only one eye very well.  Patients may be reluctant to express feelings of anger to their doctor, whether the anger is directed towards the person who may have caused the injury or even at the doctor for not being able to “save the eye”.  The bargaining phase occurs as people may try to negotiate with their “Supreme Being” (e.g., God) to restore sight in the lost eye, or help create an eye transplant which would restore sight, in exchange for promising to better control their blood sugar from diabetes, for example.  The grief stage is where people begin to realize that their life is forever changed, and may experience deep sadness and anguish.  This stage can often mimic or lead to depression.  Patients should be closely monitored to watch for signs of suicidal or even homicidal thoughts. Referral to a mental health professional is imperative in these cases. 
 
Most people experience two types of grief following the loss of an eye: loss of body image and loss of function. Loss of body image refers to the emotions that someone experiences in reaction to the way others perceive them.

 

Chapter 8

PROCEDURES (THE 3 E's)

Enucleation
 

Today, there are basically two kinds of orbital implants that are inserted into the socket after an eye is removed, those that are porous and can be integrated with the prosthesis and those that are non-porous and cannot be integrated with the prosthesis. The non-porous implants are made of an acrylic or silicone material. These spherical implants look like large marbles. They come in a variety of diameters for the surgeon to choose from.

 

Once the non-porous implant is inserted into the socket, the eye muscles that were detached from the eye are sutured (i.e., sewn) together in front of the implant. This holds the implant in place and prevents the implant from protruding forward. The two vertical muscles (superior rectus and inferior rectus) are sewn together and the two horizontal muscles (medial rectus and lateral rectus) are sewn together. These muscles are still capable of moving when the other good eye moves. Two or three more layers of orbital tissues are then sewn in front of the muscles. The socket will eventually create a fibrous layer of scar tissue around the implant. The last layer to be sewn together is the conjunctiva which is the transparent mucous membrane that covers the surface of the white part of the eye and lines the inside of the eyelids. The conjunctiva contains all of the blood vessels that make an eye red when an eye infection or inflammation exists. When the surgery is completed and if the eyelids are opened, the resulting appearance is that of a “pink wall”. This pink wall is the final layer of the conjunctiva.

 

 

 

Chapter 12

PROSTHESIS

Care and Handling

 

For the general health and well-being of the socket, an ocular prosthesis needs to be worn at all times, even while asleep, and should only be removed briefly to clean it.  A bathroom mirror is a good place for removal, since a bright light is needed and the sink provides an area to wash your hands before touching the prosthesis. The sink drain should be closed and the sink covered with a towel to prevent loss of the prosthesis or cracking and scratching if it is accidentally dropped into the sink.

 

Removal of the prosthetic eye can be done in two different ways. Most people prefer removing it by hand.  Both hands must be thoroughly washed with a gentle antibacterial soap. OcuSoft® Hand Soap is oil, dye, and fragrance-free so there’s no harmful transfer of oils or lotions (which most soaps contain) from the hands to the prosthesis to the socket. It is antibacterial and alcohol-free. Other examples of safe soaps to use include Neutrogena, Ivory bar, Opti-Soap, Dial, and any clear dishwashing liquid soap like Joy. After hand washing, it is very important to thoroughly rinse the soap off of the hands before touching the prosthesis. Soap that touches the conjunctival lining of the socket can sting and burn just as bad as getting soap in the good eye.