Services  PROPER HYGIENE AND HANDLING OF YOUR ARTIFICIAL EYE Ocularists on Staff Susan Tynes, B.C.O. & Carrie Messer, B.C.O. and Sarah Borzon  How often should the prosthesis be removed?  Unless your eye physician has given you a definite schedule for cleaning your ocular prosthesis, it is recommended not to handle or remove it too often. A general rule of thumb to follow is that if the prosthesis does not bother you, do not disturb it. The only exception would be for those individuals who are currently wearing or are in the process of being fitted for a SCLERAL SHELL OCULAR PROSTHESIS over their existing but partially damaged eye. Your ocularist will give you a wearing schedule to follow. Later, after wearing the shell several weeks or months, the ocularist or ophthalmologist may advise you on the length of time your eye can tolerate the prosthesis. Handling and cleaning the prosthesis Always wash your hands thoroughly with soap and water and rinse them well. Your fingers can transmit bacterial organism, debris, oil or other irritating foreign material into the eyes socket. Much of the daily accumulation of dried mucus and tear deposits can be removed from the eyelashes and front surface of the prosthesis by using a soft cloth, gauze or cotton swab well moistened with clear, warm water. Wipe gently toward the nose. If the accumulation is quite heavy and irritating to the eyelids, then the prosthesis should be removed and cleaned with mild soap, baby shampoo or an enzymatic contact lens cleaner. If you can not do this satisfactorily, make an appointment with an Ocularist to have the surface polished.   Excessive secretion and eye socket hygiene Unless your eyelids have been severely damaged, your tear glands will function normally; flushing small dust particles and other eye irritants from the eye socket just as they do with a living eye. The amount of tears and secretion will vary with the individual and can be considerable at times. Head colds, allergies, working in heavy dust areas, becoming overtired, being in wind, extreme temperature changes, and a poorly fitting or rough ocular prosthesis can cause excessive secretion and sometimes infection. Following a head cold or exposure to heavy dust it is advisable to remove the prosthesis and flush the eye socket. Use a syringe or an eye cup with warm water or an approved  eye wash. There are commercial drops and ointments available to remove excessive secretion and aid in lubricating the surface of the prosthesis. If an infection is apparent, consult an ophthalmologist (eye physician).   Why replace an ocular prosthesis?  An ill-fitting prosthesis can be either too small, too large, or incompatible with the socket contours. Any one of these could cause excessive secretion. Because plastic is porous, it will absorb fluids from the eye socket over a number of years. The acids in these fluids will eventually cause separation of the plastic and therefore blisters and cracks appear on the prosthesis surface. Also bacteria from the fluids will saturate the plastic and cause infections as the plastic ages. When one or several of these problems occurs, the prosthesis should be replaced. The average lifetime of a plastic ocular prosthesis is from three to seven years for an adult and from two to five years for children and adolescents. It will vary with each individual according to their physical changes. In order to avoid possible tissue damage to the eye socket and eyelids from a rough or ill-fitting prosthesis, it is important to have your ocular prosthesis checked by an Ocularist at least once a year. Small children should be checked every six months. How to insert the ocular prosthesis 1)      Hold the prosthesis so that the upper flange is upward and the back of the prosthesis  of the prosthesis is facing the eye socket. Most prosthesis have a definite “notched” area toward the nasal side. Some have been marked with a red dot on the upper flange. The prosthesis can be held by the middle finger on the nasal edge and the thumb on the temporal edge. (Figure1) 2) Raise the upper lid with a thumb or finger of the free hand, keeping the socket widely exposed.         (Figure 2) 3) Slide the upper flange of the prosthesis up under the upper lid pushing firmly until at least the pupil is hidden. (Figure 3) Sometimes, by pre-moistening the prosthesis with water, there is less friction between the lid tissue and the prosthesis. 4) With the same finger that held the upper lid open, hold the prosthesis firmly so that it does not slide downward. Take the hand which previously pushed the prosthesis up under the lid and use it to depress the lower lid enough to allow the bottom edge on the prosthesis will find its own position without any further assistance unless it was not faced properly at the beginning (step two). Some extremely large prosthesis may not be able to pass through the lid opening (palpebral fissure) when started as in step two. Identify the upper flange, but turn the prosthesis so that the narrowest flange can pass through the opening and under the upper lid. Then twist the prosthesis back to the proper position (step two) as the lower lid is pulled down. How to remove the ocular prosthesis 1) Moisten suction cup; lift upper lid so that eye lashes will not interfere; squeeze suction cup handle and place cup disc on the iris of the prosthesis (Figure 4) Suction cup will hold when squeezing action on handle is released. 2)  Pull down lower lid enough to allow the lower edge of the prosthesis to be seen (Figure 5) Twist the prosthesis counter-clock-wise and lift up and out (Figure 6)  IMPORTANT POINTS TO REMEMBER 1) Do not clean the prosthesis with anything abrasive. Never use alcohol or other solvent as they will damage a plastic prosthesis. 2) Always wipe toward your nose when cleaning the lids or rubbing an itch. Wiping outwards will dislodge the prosthesis. 3) When washing around your eyelids, use a soft, moist cloth. Never wrap the prosthesis in a piece of tissue. Many have lost their prosthesis accidentally discarding the tissue. 4) Swimming with the prosthesis is fine provided you do not dive or open you eyes under water. Use goggles, or remove prosthesis if you plan to dive under water, or participate in any water sports. 5) Consult your ophthalmologist (eye physician) should any infections or other problems arise relating to your eyes. 6) If you must remove the prosthesis for any length of time, keep it in a container immersed in water. Otherwise the prosthesis can become discolored. 7) Have the prosthesis checked and re-polished at least once a year by an Ocularist. Always consult a professional When wishing to consult someone about your artificial eye, it is advisable to see an ocularist who is Board Certified or one who is actively working toward becoming eligible for certification. Most ocularist are located in the larger cities throughout the United States and Canada. Many travel to the smaller cities on a regular schedule if you are moving to another part of the country, ask your present ocularist who he/she recommends in your new location. A national registry of current Board Certified Ocularist is published annually. Remember, an artificial eye making firm is only as good as the amount of skill and experience of the individual ocularist. Those ocularist who are in the process of becoming eligible for certification have either had directly supervised or partially monitored training by a Board Certified Ocularist.  Most are graduates of a five year curriculum in ocularist offered by the American Society of  Ocularists. All must devote at least fifty one percent of their practice to fitting and fabricating artificial eyes. A Board Certified Ocularist must maintain his certification by earning continuing his education credits through attendance and passing courses on current concepts in ocularistry. These courses are offered by the American Society of Ocularist and other ophthalmic symposiums approved by the National Examining Board of Ocularist. A recertification examination must be passed every six years.