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Ocular Prosthesis Case History

This document contains a case history sheet for customized prosthetic eyes. It collects personal details of the patient such as name, age, address, medical history including details of the eye removal surgery. It also documents the examination of the remaining normal eye and socket, including details of the size, color, healing and any other conditions. The treatment plan and evaluations of the final prosthetic eye are also included.

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drsmriti
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523 views5 pages

Ocular Prosthesis Case History

This document contains a case history sheet for customized prosthetic eyes. It collects personal details of the patient such as name, age, address, medical history including details of the eye removal surgery. It also documents the examination of the remaining normal eye and socket, including details of the size, color, healing and any other conditions. The treatment plan and evaluations of the final prosthetic eye are also included.

Uploaded by

drsmriti
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as DOCX, PDF, TXT or read online on Scribd
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Department of Prosthodontics and Maxillofacial Prosthetics,

Peoples Dental College and Hospital,


Naya Bazar, Kathmandu
Case history sheet for Customized Prosthetic eye
Registration number:
Case number:
Date:
Personal details:
Name of the patient:
Age/sex: Address: permanent___________________
present______________________
Marital status:
Occupation:
Education:
Phone nos: Residence:
Mobile:
Email id:
Clinical presentation:
Enucleation Evisceration
Atropy others_________________________
Cause:


History of presenting illness:



Duration:

If surgery: What:

When:

Medical history/status:


Psychological history:

Prosthetic history:
If yes,
Ready-made Customized
Duration:
Patients opinion regarding the previous prosthesis:
Evaluation of prosthesis:
Examination of normal eye:
Opening: adequate inadequate
Eyelids:
Mobility:
Size of iris: 10 10.5 11 11.5 12
Color:

Pupil size: During clinical light__________mm
During light activation__________mm
Sclera color:
Any characterization:
Blood vessels:

Examination of anapthalmic socket:
Site: Right Left

Healing: Adequate Inadequate

Socket bed: Healing Inflamed

Irritation: Absent Mild Severe

Mobility of bed: Adequate Mild Absent

Depth of fornices: Upper Lower

Ocular implant: Present Absent

Position of ocular implant

Size of socket

Any other condition: Tissue adhesion Growth Others
Examination of anapthalmic eyelids
Opening of : upper
lower
Tonicity:

Musculature support: adequate inadequate

Relationship of palpebral fissure with normal site:
a) Opening symmetrical asymmetrical
b) Closing symmetrical asymmetrical

Any other findings:
Grafted eyelid scar contracture wound dehiscence

Any discharge:


Diagnosis:

Treatment plan:

Laboratory evaluation of the final prosthesis:




Clinical evaluation of the final prosthesis:
Size
Shape
Color of pupil/iris/sclera
Support
Mobility
Retention
Symmetry
Characterization
Patients opinion:

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