A 47 y.o. pt with bipolar disorder presents with R eye drainage

What is wrong with her eye?

Our patient had an ocular implant after being hit in the eye with brass knuckles and requiring an evisceration for severe pain. The sclera is sewn together over an acrylic implant and a plastic contact lens covers it. The acrylic implant is porous and allows vessels to incorporate into the implant and allows the secure attachment of extraocular muscles improving mobility of the prosthesis. An artificial eye will be added at a later date.

Surgical removal of the eye was first reported in the 1500’s. the first report of an implant after enucleation was in 1886.  In the past glass balls were used to replace the eye but more recently porous substances are use. Hydroxyapatite which is created from coral is often used.

ocular implant made from coral

Rarely,  following eye injury, sympathetic ophthalmia occurs which is thought to be due to an autoimmune inflammatory response toward ocular antigens; a delayed hypersensitivity to melanin in the photoreceptors in the retina. Although rare, this condition results in blindness so high dose immunosuppression is needed.

Treatment is changing for sympathetic ophthalmia since nanoparticles are being use to penetrate the cornea.The corneal epithelium  has multiple layers of epithelial cells which interconnect by tight junctions limiting the penetration of drugs in the past. Recent research has associated active molecules with naonocarriers to overcome ocular barriers and may be important in treating retinal diseases in the future.

Weng Y, Liu J, Jin S, Guo M, Liang X, Hu Z.  Nanotechnology-based strategies for treatment of ocular disease. Acta Pharm Sin B. 2017 May;7(3):281-291.

Phan LT, Hwang TN, McCulley TJ. Evisceration in the modern age. Middle East Afr J Ophthalmol. 2013 Jan:19(1):24-33.

Jordan DR.  Problems after evisceration surgery with porous orbital impalnts: experience with 86 patients. Ophthalmic Plast Reconstr Surg 2004 Sep 20(5):374-80.

Sami D, Young S, Petersen R. Perspective on orbital enucleation implants. Surv Ophthalmol 2007;52(3):244-65.