Case study 4

Take home message:
Some patients feel stronger for having overcome the obstacles in their life – including the loss of their eye.
If your damaged eye is blind and distressed it is better to have it removed sooner rather than later.

Glossary of terms:
Evisceration : An operation whereby the iris is incised away allowing the eye-ball to drain and collapse.
Atrophy : A wasting away of part of the body.

Background:
Raewyn Burnham is full of life and a delight to all those who know her and have been helped by her. She is looking
forward to her 70th birthday when she will spend a happy time with her blended family of 5 children and 7 grandchildren plus numerous friends and colleagues. But things haven’t always been so easy for this bright and cheerful soon to be septuagenarian. When Raewyn’s right eye was lacerated by a piece of wire at age 40 her life took a dramatic turn for the worse. Her damaged eye became more and more unsightly as an opaque white cataract formed over the iris and she became very self-conscious about her appearance.

The stress contributed to the breakdown of her marriage but after this happened she was forced to take stock of her situation. She had 2 children to bring up, looked awful and had no career. So what did she do? She began training as a midwife, qualifying in 1986. Raewyn has delivered thousands of babies since and is now a pregnancy consultant, providing expert advice to young mothers and pairing them up with suitable midwives. She even stood for election to the Waitemata District Health Board and almost made it. Raewyn’s disfigured eye was finally eviscerated in 2007 and Keith Pine made and fitted her new artificial eye.

“The difference was amazing.” said Raewyn. “For years I put up with a horrible looking eye and in 6 short weeks I was suddenly normal – I should have had my eye out years ago”

Patients often put up with years of pain and embarrassment before they finally agree to have their eye enucleated. “It is the dread of losing an eye. The finality of it; that makes the decision so hard.” Once they receive their prosthesis however, a common response is: “I should have had my eye out years ago.” Looking back, Raewyn has no regrets about the way she has lived her life and feels stronger for having overcome the hardships associated with the loss of her eye.

Review of prosthesis and socket:

Raewyn attended her annual appointment for checking and re-polishing her artificial eye in October 2008.
The prosthesis (fitted the previous year) was comfortable but the socket had atrophied a little, causing the eye to fall
back and gaze upward.

Treatment:
An impression was taken of the socket and a replacement prosthesis made and fitted. This new prosthesis is bulkier
on the upper edge than the previous one and its front surface is more curved – albeit not as curved as the natural eye due to considerations of lid contour. It took a couple of days for Raewyn’s socket to accomodate the slightly larger prosthesis but was very comfortable after that. Raewyn was advised to continue to remove and clean the artificial eye once a month. She will be recalled for a check and re-polish in twelve months time. Raewyn’s prosthetic eyes are fully funded by ACC.

Many happy returns for your 70th birthday Raewyn, and thank you for being such an awesome patient.