Referring to the NAES
All patients who have not previously been seen by the NAES will need a new referral with a doctor’s signature. Patients who have not been seen for some time, or whose clinical situation has changed, may also need a new referral. This is because the referral contains a prescription for topical anaesthetics and other items which might be used during treatment. Please contact the NAES on 01253 951131 or firstname.lastname@example.org to find out if a patient already has a referral, or to request a referral form. Alternatively, a form can be downloaded here but must be signed by hand by a medical doctor.
Patients who have been seen within the last five years should be registered on our database, and can arrange an appointment by calling our booking line. We are unable to book appointments in clinic.
What kind of prosthesis does my patient have?
If there is a shrunken or damaged eye, or part of one, still present in the socket, then the patient will be classed as having a ‘cosmetic shell’ prosthesis. If the eye has been removed (including either enucleation or evisceration with possible implant) or there was never an eye in the socket, as in anophthalmia, then this will be an ‘artificial eye’ prosthesis. This distinction is important in knowing what care the patient needs. If the lids or bony orbit have been removed or exenterated, this will require a facial prosthesis which is not provided by the NAES, and is normally produced by a maxillo-facial team. If further clarification is needed, please contact us.
A very few patients still wear actual glass eyes, rather than acrylic which has been the standard for more than fifty years. These patients may need additional arrangements; please contact us for more information.
Discharge and infection – In cases where a patient has not been seen for an extended period of time, the salts and proteins from the tears can dry on the surface of the prosthesis. This can leave a rough and abrasive surface, which causes an increase in discharge and discomfort as well as an increased vulnerability to infection. If a person with an orbital prosthetic has not been seen by the NAES for several years, and is experiencing recurrent infection, it may be due to a heavily-coated or mechanically damaged prosthesis. They should request an appointment with the NAES to resurface and polish the prosthesis.
Lost prosthesis – while rare, some patients do lose their orbital prostheses. This can lead to problems with socket contraction, and if they do not have a spare prosthesis then they will need a temporary shape fitted as soon as possible. Please contact us and explain that the patient does not have/is not wearing a prosthesis.
Should the prosthesis be left out?
We strongly recommend that artificial eye prostheses are left in wherever possible. This is because the artificial eye maintains the socket volume, and if it is left out for more than a day or two the socket and lids can contract down. This can make it very difficult to replace the prosthesis, and in severe cases of contraction can make it impossible to refit any shape. Unless the prosthesis is damaged or painful to wear, the prosthesis should be worn as much as possible. Some patients do take the artificial eye prosthesis out overnight, but any longer than this can cause problems.
We advise that cosmetic shell prostheses are not worn overnight, so these should be left out while sleeping. Cosmetic shells can generally be left out for a prolonged period if the patient feels it is necessary or more comfortable, as the remaining part of the eye will maintain the socket volume.
Subject to your particular hospital’s procedures, there is no reason to remove an artificial eye prosthesis for or during surgery under anaesthesia. Patients are generally more comfortable wearing their prosthesis, and they can be lost or damaged if left out for in-patients.
Magnetic implants and radiography
Some patients may have an orbital implant comprising an acrylic hemisphere with a magnet embedded centrally. As these were most common around fifty years ago, it is possible that some of these patients may not be aware that they have a magnet in their socket. This can obviously present issues during MRIs. We advise that any patient with an artificial eye who is not sure what sort of implant they have is not given an MRI without a check of the orbit; either with the NAES’ records or with an x-ray. Radiography protocols regarding unknown orbital implants reflect this.
Where can I find out more about orbital prosthetics?
If you are located close to Blackpool, then we can arrange visits or education sessions at the NAES Headquarters site. For other locations, your local Orbital Prosthetist will be happy to arrange training or clinic observation sessions for a range of contexts. Recently, we have delivered training sessions for medical students, ophthalmic nursing teams, optometrists and theatre teams. Please contact us for further information.
Helpline number: 01253 951131 or email email@example.com