Case study 11

Take home message:
Distressing conditions such as bilateral microphthalmia bring out extraordinary depths of love and compassion.

Glossary of terms:
Microphthalmia is a developmental disorder of the eye that literally means ‘small eye’.
Anophthalmia is the congenital absence of one or both eyes.

Background:
Little Conner Bright and his family are extraordinary. Born with microphthalmia and an abnormal cornea in both eyes, Conner is destined never to see. When his mother Nicola learned about his condition shortly after he was born she was very, very upset. “I was gutted. I went kind of crazy”. Now, one year later, Conner’s parents feel blessed to have him. “Everyone is so in love with Conner – even strangers in the street.”

Nicola is looking forward to Connor walking and talking. “He has started to move around and it’s very exciting.”

Review of prosthesis and socket:
Conner was 10 months old when he first attended Keith Pine’s clinic to be assessed for orbital expander shells. This is later than normal but because both of Conner’s eyes are affected in the same way it is less critical than when only one eye is affected. The presence of the eyeball stimulates the hard and soft tissues of the orbit to grow in line with the rest of the face. If one eye is missing (anophthalmia) or under-developed (microphthalmia) the growth on the affected side lags behind, causing the face to become asymmetrical. With two microphthalmic eyes, Conner’s face will grow evenly, albeit a little differently.

Orbital expanders are substitutes for the natural eyeball and  stimulate the growth of the orbital tissues – custom-made clear  plastic conformers are replaced every few weeks with larger ones.

The first set of conformers (illustrated) was made from an impression of Conner’s eyes using polyvinyl siloxane. This was done at 10 months and Conner actually enjoyed the sensation it caused.

Prior to having his conformers fitted, Conner’s eyes were always closed but the conformers opened his eyelids and for the first time he could ‘see’ light. When he is older Conner will be able to describe his light perception and decide whether it is useful, or whether he would prefer artificial eyes.

Conner’s family have a lot to cope with but they are wonderfully aware of the richness of life and the love that he inspires in them.