Losing an eye can involve months of emotional trauma, surgery, treatment and recovery, but artificial replacements are almost indistinguishable from the real thing. Angie Mezzettireports.
British Prime Minister Gordon Brown and Peter Falk, the actor who played Columbo the detective in the trench coat, each have one artificial eye. Brown lost his left one as the result of a detached retina, the result of a kick in the head he received during a rugby match in his teens.
Peter Falk's right eye was surgically removed at the age of three due to a malignant tumour. Both have gone on to live full lives and Falk has not only had a long and successful acting career, he is also a very skilled artist.
In the past, it was mostly car crashes that often resulted in people losing an eye, according to Paul Moriarty, consultant ophthalmic surgeon at the Royal Victoria Eye and Ear Hospital in Dublin.
"Patients often suffered traumatic losses. These numbers have diminished dramatically now because of seatbelt usage, laminated windscreens and airbags, although sometimes sudden expansion of an airbag can cause bruising."
There are other reasons why people lose eyes. "Sometimes it is because of cancer or surgical failure for retinal detachment, sometimes children can be born without an eye, 'anophthalmus'."
However, he says eyes are often lost though accidents, particularly industrial accidents. "Things like chainsaws, or nails being hammered can cause an eye to be destroyed. Domestic accidents can occur because of simple things like a child falling on a pencil, coat hangers being carried down a stairs when someone falls or rebounding shards from plates falling on hard floors."
He believes patients are more aware now that so much can be done for them. "When a person loses an eye, the socket can be quite big and so a prosthesis would be equally big and therefore heavy.
"We now replace part of the socket with an implant buried in the tissue. We replace it with a plastic sphere covered with donor sclera, but this has been curtailed with the onset of CJD and most sclera now comes from the US."
The saucer-shaped prosthetic eye is then fitted in the smaller socket.
Cancer in the face or the eye itself will often result in surgery to remove the eye. Sometimes a healthy eye has to be removed, even when the cancer is in the soft tissue around it.
"Children who have had intensive radiotherapy and chemotherapy where tissue has been weakened may need facial prosthesis in addition to the artificial eye to give them back some structure," he says.
This is where the expertise of a prosthesis maker comes in as it must be managed and replaced as the child grows. Some prosthesis makers will even make two facial prostheses where the skin matches with summer and winter skin colours changes.
Mervyn Nixon makes and fits prosthetic eyes and has seen clients of all ages from babies to older adults in his clinic in South Circular Road in Dublin.
"They used to be known as 'glass eyes' but now they are made from acrylic and can be made for the client in a day.
"The Germans still make them from glass but they are more susceptible to heat and cold changes and, of course, breakages," he says. By making them with acrylic they can correct colours in the iris quickly.
"We have a lab locally so we can get people sorted out, start to finish, in one day. This is especially important for people coming from the country who can then combine it with a hospital visit or other business in the city."
In Britain, the process can take up to a week. On rare occasions, Nixon has had to help bomb victims, such as in the aftermath of the Omagh bombing.
"It can be a very emotional experience coming to get a prosthetic eye. On the first visit to the clinic, I will often spend an hour or more just talking to a client and allowing them to cry," says Nixon.
"They think life has finished so sometimes we do nothing initially. But when they find that they can go out of here with a perfect match to their socket size and eye colour, they realise they can get back to a normal life again and they are thrilled."
Some of the main fears patients have, he says, are simply having to handle the artificial eye, inserting and removing it and routine cleaning of the prosthesis. Nixon recommends taking it out on a daily basis for cleaning and having a check up every two years.
"The protein builds up on the surface of the artificial eye and the structure starts to breakdown after a while. This can result in a discharge from the eye socket or the client may have problems with eyelid closure." He recommends gentle cleaning with a toothbrush set aside for the purpose. "People also fear not being able to cry but usually this is not a problem as the tear ducts are separate from the eyes."
Another fear clients have is that others will notice the new prosthetic eye. "When they see how normal they look again they get a great confidence boost. They go out of here a whole person again ready to face the world."
Nixon usually provides a second eye with a larger pupil for nightwear. This also serves as a back up in case the artificial eye ever gets lost or mislaid. "With regular check ups the prosthesis will only need to be replaced every 10 years."
The cost of a new prosthetic eye is anywhere from €700 to €900. This is usually covered by the health board and health insurers.
Prosthesis maker and fitter Robin Brammer from Manchester has been helping people for more than 40 years in Manchester and visits Dublin once a month to see clients.
He sees between 1,000 and 2,000 clients a year and says there have been changes in the types of injuries causing the loss of eyes.
"It used to be road-traffic accidents and industrial accidents but with the health and safety legislation and training we are now more likely to be treating people who have lost eyes through violence and drug-related crime," he says. "Children's bows and arrows used to be a major cause but now it's more likely to be DIY gardening."