Elise’s Prosthetic Eye Change

Unlike real eyes, prosthetic eyes don’t grow, and in children who grow quickly, they need to be replaced once every few years. Elise’s first prosthetic eye was done in April 2017. We observed that the prosthetic eye kept moving out of alignment. After a consultation with Dr Ganga, he advised us to get a new one fitted.

Prosthetic eyes are handmade, and the process requires roughly three working days, including the time it takes for curing and drying. We got ours done with the same ocularist at NUH, Dr Sue.

The clinic is a small enclosed space featuring some prosthetic samples. The more complicated eye prosthetics include those made of latex to mimic the flesh surrounding the eye.

This is the imprint of Elise’s eye cavity and this is what the base of the prosthetic eye has to look like in order for it to fit snugly. I didn’t take a photo, but this was done by pouring a mixture through a mould that was fitted onto her eye cavity.

This is a brief summary and I can’t fully convey the full experience as 80% of the time involved waiting – Elise playing or on the phone watching YouTube, me mindlessly checking social media. On one particular day, I packed in a huge sticker book and other activities and my shoulder nearly gave way because I carried a tote bag.

It involves a lot of fitting and adjustment to get the angle and position right. Mainly, what we want to do is to determine the specific placement of the pupil, whether it should be right smack in the centre, or a little nearer to the nose.

Time for a #momjoke – this is Elise side-eyeing her eye. Every eye is handmade and it’s not one-size-fits-all. It’s not oval shaped, but it has a little pointed tip at the top so it holds in place.

Next, Dr Sue adds details to the eye using pigments to make it more realistic. Most of the time for Asian children, their pupils are black. Westerners have more complicated eye details and there’s a technology that can print the pupil onto the base, but it’s a film and likely isn’t as lasting.

Dr Sue mostly handles Asian patients, and paints the details by hand. This won’t be Elise’s last prosthetic eye, and we will likely have to fabricate a few more eyes before she reaches adulthood.

One thing Dr Sue advised was not to remove the prosthetic eye regularly as it affects her lower eyelid and its capability to hold the eye.

This is how she looks like now with the new eye! Due to the better fit, it doesn’t move around that much anymore. It has limited functions, like it can’t follow along when she rolls her eyes, something she does pretty often nowadays, but it’ll do!

Finding Peace

After receiving calls about Emmett’s biting for the past two days, I was bracing myself to hear how his next victim got attacked when it turned out to be another teacher instead. “Hello Elise’s mummy, Elise’s contact lens fell out, could you come down to put it back in? We don’t know how to put it back. Please come down now.”

Elise has been using her prosthetic eye for about 2.5 years now.

She is unable to see through that eye and it is to make her appear as if she has two eyes like everyone else. It isn’t immediately noticeable, but as the prosthetic eye is merely a cover, the pupil does not move when her natural eye does. It does not need to be removed daily, but it can be taken out for cleaning. Sometimes, when she rubs on her eye too hard, it may fall out, which is what happened today.

It brought my mind back to the first time it happened when I was alone with her. One moment, she was playing around, and the other moment, she was staring at me with an empty socket. I freaked out and immediately called the prosthetic doctor while alerting my closer friends on WhatsApp “OMG ELISE’S EYE JUST DROPPED OUT WHAT DO I DO”. I was ready to bring her to the hospital so that the doctor could insert it back for her (and me). The doctor encouraged me to try it myself first, instructing me over the phone.

Back then, she was much younger and she would not stay still because she was traumatised by her experience of being held down forcibly for tests, eye dressing changes and her wound was possibly tender and healing. It was like pinning down a squealing piglet destined for slaughter. My feelings were a mish-mash of guilt, fear, shock and pity. Eventually, I slot it in without going to the hospital.

Emotionally, it was saddening for us to come to terms with the fact. Up till now, I don’t think my husband has seen her eye socket yet.

Back to today. The same situation occurred and I saw how shocked her teachers were. They managed to cover Elise’s eye and move her to the office before other children took notice. Her form teacher told me that she couldn’t bear to look. It’s completely natural for them to have that response and I don’t blame them. After all, it’s not something they encounter often and most people can’t deal with seeing something like that. If you’re curious, her eye socket has healed and it is neither bloody or has dangling veins. It appears as pink hollow flesh.

I washed it under running water before popping it back in. Over the years, both of us has gotten used to it. Elise has observed her appearance in the mirror without her prosthetic eye (I advised her not to, she insisted) and her reaction was not one of fear or disgust. It seems that she understands and is living without noticeable problems. She can run, kick a ball and balance on beams.  However, at 3 going on 4 years old, people around her are less likely to make snark remarks about appearance. We will cross that bridge when we get to it.

Elise’s New Eye

We’d wanted to get Elise’s prosthetic eye done sooner, but the plans were postponed because of a “bubble” which hadn’t completely healed which would affect the molding of the ocular prosthesis. Well, after 3 consecutive days at the Ocular Prosthesis department (just a small room located inside the Dermatology clinic), Elise got her new eye! As it is made of medical grade plastic acrylic, it obviously does not have the capability of enabling her to see through it – it is purely for aesthetic purposes. Current technology hasn’t yet advanced to the stage where they can make the fake eye send signals to the brain to process it. Maybe in a few more decades, if we haven’t utterly destroyed the world by then with our wasteful practices.

My husband feels extremely guilty about not insisting on getting her checked when we first noticed her lazy eye and tells Elise often that he will get a seeing eye implanted for her when she turns 30. Let’s see! The ocularist says this should be able to last her for the next 2 to 3 years, after which we’ll need to create another one again.

The moment we got it fitted, I sent photos to the in-laws, who were exhilarated. According to my husband, my brother-in-law cried tears of joy. They’ll get to see her looking like nothing ever happened when we visit next month. The prosthetic eye was entirely customised, which explains the price (S$1,500). Since prostheses are not considered a necessary expense, it’s neither covered by insurance or subsidy. For something like this that affects her appearance and self-confidence, we’ll have to pay even if it costs $5,000 or $10,000.

(L) Prosthetic eye (just a sample, not Elise’s), (R) Plastic conformer with iris

On the left is how a prosthetic eye looks like. Everything is handpainted. On the right is a plastic conformer with black iris that Elise used up till yesterday. In most hospitals, clear plastic conformers are used. Without the iris, the redness of the eye muscle can be clearly seen and it affects caregivers and others psychologically. I turned away when the ocularist removed her conformer to make adjustments. I did glance over once and saw the pinkish patch where her eye used to be. The pinkish patch is actually her eye muscle, stitched together after her eyeball was removed and replaced with a plastic orbital implant.

Another reason why we had to create the prosthetic eye instead of relying on the conformer alone was because the conformer is convex and hollow on the inside whilst the prosthetic eye is carefully molded according to the individual. Using the conformer long term may result in sagging and possible deformation of the face for growing children. The prosthetic eye appears normal in photos but in real life, it becomes easier to identify as the “pupil” will not be able to move as freely as the real eye.

We met some neighbours at the void deck on our way home and they said it looked much better than the conformer. With the conformer, we did get questions from curious strangers who asked if she had a “red eye”. It was tiring having to repeat ourselves. Luckily, she is still at the age where she cares more about whether she gets to go downstairs to play than how she looks like, and we haven’t met nasty people or children who taunted or made fun of her.

It’s been a long 5 months.

The day she had her right eye and the tumour removed.

A few days before fitting the prosthetic eye. The in-between stage after the dressing was removed and before her bruise went away is too saddening to post. The bruise made her right “eye” appear significantly lower than the left 🙁

To better days ahead!