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Not a handicap

Though there are situations that can lead to the loss of an eye, such victims needn't despair. They can undergo rehabilitation for aesthetic, functional and psychological reasons.


The loss of an eye ... the world needn't be a blur

IT is not infrequent to come across people who have sustained permanent damage to one of the paired structures of the body like the lungs, the kidneys and the eyes. Once we see them, it does set us thinking about what it is like to carry on leading a normal life. The fact is that the body's ability to cope with such situations is amazing.

As regards vision, while people who are monocular are able to perform almost everything that a binocular person does, there are a few functional and other limitations, some of which can be overcome. For example, even simple acts like threading a needle or pouring a drink into a cup can become a challenge. Likewise, getting used to limited peripheral vision especially in situations like when there is heavy traffic or the industrial work place with fast moving equipment can not only become unnerving but at times also hazardous.

Commonplace situations that can lead to a loss of an eye include intentional surgical removal of the eye for intraocular tumours, severe irreparable trauma to one eye which may pose a threat to the normal eye, infections when vision is irreversibly lost, and when a blind eye is disfigured or results in chronic irritation and pain. Such persons, once considered the end of the road cases as far as the ophthalmologist was concerned, can now undergo further rehabilitation for aesthetic, functional and psychological reasons.

The individual who is blinded in one eye undergoes an adaptational process to resume leading a normal life. This includes a relearning of spatial orientation, depth perception at near and far using various visual cues and greater movement of the working eye and head to cover a larger field, etc. From the medical point of view, given that there is only one eye, ophthalmologists recommend the following:

Wearing protective eye wear at all times, preferably made of polycarbonate lenses which are shatter proof, especially when outside the home environment, be it while driving, at school or at work. This is because, when exposed to injury, it is the "seeing eye" which is more likely to be injured.

That the only "seeing eye" be subject to periodic and complete ophthalmic evaluations to recognise early diseases.

Potential traumatic situations including contact sports and hazardous situations should be avoided, even if it means a review of the person's job description.

Physical rehabilitation of the patient includes various modalities. The most simplistic, and common, form is to place an artificial eye (prosthesis) in the eye socket. While this is frequently done by fitting a "stock eye" from a box, much like selecting a shirt from a clothing store which may or may not fit well, in the developed world and in a handful of centres in India, a "customised prosthesis" is tailored to suit the person's needs with much superior cosmesis.

When an eye is removed surgically, an implant is placed in the socket, usually at the same sitting, to act as a foundation on which the prosthesis rests and moves to a certain extent.

For any reason if a primary implant is not placed, secondary implants may be used. Choices of these implants are varied and the current generation of implants are designed to integrate with the orbit such that the overlying prosthesis may be coupled to the underlying implant for better movement. However, the latter is not without certain limitations and hence used in a limited way.

Finally, in the Indian environment we do come across patients who have had their eyes removed several years earlier before they finally seek attention. More often than not, due to the delay and lack of adequate care of the socket, a ready fitting of the artificial eye is impossible.

In such situations, major reconstructive surgery may be required either using synthetic materials or the patient's own tissues before fitting him with an acceptable prosthesis.

Dr. J.K. GANGADHARA SUNDAR
Dr. MOHAN RAJAN
Dr. SUJATHA MOHAN

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