Cryolite glass prosthetic eyes—the response of the anophthalmic socket

  • Alexander C. RokohlEmail author
  • Werner Adler
  • Konrad R. Koch
  • Joel M. Mor
  • Renbing Jia
  • Marc Trester
  • Nicola S. Pine
  • Keith R. Pine
  • Ludwig M. Heindl
Oculoplastics and Orbit



To investigate mucoid discharge and the inflammatory response of anophthalmic sockets to cryolite glass prosthetic eye wear.

Patients and methods

A total of 101 cryolite glass prosthetic eye wearers used visual analog scales (0–10) to measure frequency, color, volume, and viscosity of mucoid discharge associated with their prosthesis. Standardized photographs of the conjunctiva of their anophthalmic sockets were taken and conjunctival inflammation was semi-quantitatively graded (0–4). All characteristics of discharge and conjunctival inflammation were correlated to eye loss cause, hand washing behavior, and cleaning regimes as explanatory variables.


Mean mucoid discharge characteristics (0–10 scale) were frequency 5.3 ± 2.8, color 4.8 ± 3.2, volume 4.9 ± 3.0, and viscosity 5.1 ± 3.2. The mean conjunctival inflammation score (0–4 scale) was 2.1 ± 1.0. There was a positive correlation between the grade of conjunctival inflammation and the frequency (p = 0.018), color (p = 0.001), volume (p = 0.003), and the viscosity of mucoid discharge (p = 0.005). More conjunctival inflammation was associated with higher frequency of cleaning (p < 0.001) and lower frequency of hand washing before removal (p = 0.001). Higher frequency, color, volume, and viscosity of discharge were associated with higher frequency of cleaning (p ≤ 0.001).


Discharge severity associated with prosthetic eye wear was positively correlated with more conjunctival inflammation, higher cleaning frequency, and less hand washing before handling. The results suggest that cryolite glass eyes should not be removed daily for cleaning and that further research should be undertaken to develop a standardized treatment protocol for managing inflammation and mucoid discharge. This protocol would advise hand washing before handling cryolite glass eyes and recommend a minimum period of wear between cleaning sessions.


Prosthetic eyes Ocular prostheses Anophthalmic socket Enucleation Eye loss Discharge 


Compliance with ethical standards

Conflict of interest

Alexander C. Rokohl, Werner Adler, Konrad R. Koch, Joel M. Mor, Rening Jia, Nicola S. Pine, Keith R. Pine, and Ludwig M. Heindl certify that they have no affiliations with or involvement in any organization or entity with any financial interest (such as honoraria; educational grants; participation in speakers’ bureaus; membership, employment, consultancies, stock ownership, or other equity interest; and expert testimony or patent-licensing arrangements), or non-financial interest (such as personal or professional relationships, affiliations, knowledge, or beliefs) in the subject matter or materials discussed in the manuscript. The participants in this study were recruited from the Trester-Institute for Ocular Prosthetics and Artificial Eyes in Cologne that is owned and operated by M. Trester. All authors have full control of all primary data and they agree to allow Graefe’s Archive for Clinical and Experimental Ophthalmology to review their data upon request.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional research committee of the University of Auckland and of the University of Cologne and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Informed consent

Informed consent was obtained from all individual participants included in the study.


  1. 1.
    Pine K, Sloan B, Stewart J, Jacobs RJ (2011) Concerns of anophthalmic patients wearing artificial eyes. Clin Exp Ophthalmol 39:47–52. Google Scholar
  2. 2.
    Rokohl AC, Koch KR, Trester M, Trester W, Pine KR, Heindl LM (2017) Concerns of Anophthalmic patients wearing Cryolite glass prosthetic eyes. Ophthal Plast Reconstr Surg.
  3. 3.
    Pine NS, de Terte I, Pine KR (2017) An investigation into discharge, visual perception, and appearance concerns of prosthetic eye wearers. Orbit 36:401–406. CrossRefGoogle Scholar
  4. 4.
    Mourits DL, Hartong DT, Budding AE, Bosscha MI, Tan HS, Moll AC (2017) Discharge and infection in retinoblastoma post-enucleation sockets. Clin Ophthalmol 11:465–472. CrossRefGoogle Scholar
  5. 5.
    Pine KR, Sloan BH, Jacobs RJ (2013) A proposed model of the response of the anophthalmic socket to prosthetic eye wear and its application to the management of mucoid discharge. Med Hypotheses 81:300–305. CrossRefGoogle Scholar
  6. 6.
    Pine KR, Sloan B, Jacobs RJ (2012) Deposit buildup on prosthetic eyes and implications for conjunctival inflammation and mucoid discharge. Clin Ophthalmol 6:1755–1762. CrossRefGoogle Scholar
  7. 7.
    Rokohl AC, Koch KR, Adler W, Trester M, Trester W, Pine NS, Pine KR, Heindl LM (2018) Concerns of anophthalmic patients-a comparison between cryolite glass and polymethyl methacrylate prosthetic eye wearers. Graefes Arch Clin Exp Ophthalmol.
  8. 8.
    Han JW, Yoon JS, Jang SY (2014) Short-term effects of topical cyclosporine a 0.05% (Restasis) in long-standing prosthetic eye wearers: a pilot study. Eye (Lond) 28:1212–1217. CrossRefGoogle Scholar
  9. 9.
    Pine K, Sloan B, Stewart J, Jacobs RJ (2012) A survey of prosthetic eye wearers to investigate mucoid discharge. Clin Ophthalmol 6:707–713. Google Scholar
  10. 10.
    Bohman E, Roed Rassmusen ML, Kopp ED (2014) Pain and discomfort in the anophthalmic socket. Curr Opin Ophthalmol 25:455–460. CrossRefGoogle Scholar
  11. 11.
    Kashkouli MB, Zolfaghari R, Es'haghi A, Amirsardari A, Abtahi MB, Karimi N, Alemzadeh A, Aghamirsalim M (2016) Tear film, lacrimal drainage system, and eyelid findings in subjects with Anophthalmic socket discharge. Am J Ophthalmol 165:33–38. CrossRefGoogle Scholar
  12. 12.
    Pine KR, Sloan B, Jacobs RJ (2013) The development of measurement tools for prosthetic eye research. Clin Exp Optom 96:32–38. CrossRefGoogle Scholar
  13. 13.
    Pine KR, Sloan B, Stewart J, Jacobs RJ (2013) The response of the anophthalmic socket to prosthetic eye wear. Clin Exp Optom 96:388–393. CrossRefGoogle Scholar
  14. 14.
    Litwin AS, Worrell E, Roos JC, Edwards B, Malhotra R (2017) Can we improve the tolerance of an ocular prosthesis by enhancing its surface finish? Ophthal Plast Reconstr Surg.
  15. 15.
    Toribio A, Marrodan T, Fernandez-Natal I, Martinez-Blanco H, Rodriguez-Aparicio L, Ferrero MA (2017) Study of conjunctival flora in anophthalmic patients: influence on the comfort of the socket. Graefes Arch Clin Exp Ophthalmol 255:1669–1679. CrossRefGoogle Scholar
  16. 16.
    Jones CA, Collin JR (1983) A classification and review the causes of discharging sockets. Trans Ophthalmol Soc U K 103(Pt 3):351–353Google Scholar
  17. 17.
    Pine KR, Sloan B, Han KI, Swift S, Jacobs RJ (2013) Deposit buildup on prosthetic eye material (in vitro) and its effect on surface wettability. Clin Ophthalmol 7:313–319. CrossRefGoogle Scholar
  18. 18.
    Paranhos RM, Batalhao CH, Semprini M, Regalo SC, Ito IY, de Mattos Mda G (2007) Evaluation of ocular prosthesis biofilm and anophthalmic cavity contamination after use of three cleansing solutions. J Appl Oral Sci 15:33–38CrossRefGoogle Scholar
  19. 19.
    Christensen JN, Fahmy JA (1974) The bacterial flora of the conjunctival anophthalmic socket in glass prosthesis-carriers. Acta Ophthalmol 52:801–809CrossRefGoogle Scholar
  20. 20.
    Sun MT, Pirbhai A, Selva D (2015) Bacterial biofilms associated with ocular prostheses. Clin Exp Ophthalmol 43:602–603. CrossRefGoogle Scholar
  21. 21.
    Härting F, Flörke OW, Bornfeld N, Trester W (1984) Surface changes in glass eye prostheses. Klin Monatsbl Augenheilkd 185:272–275. CrossRefGoogle Scholar
  22. 22.
    Koch KR, Trester W, Muller-Uri N, Trester M, Cursiefen C, Heindl LM (2016) Ocular prosthetics. Fitting, daily use and complications. Ophthalmologe 113:133–142. CrossRefGoogle Scholar
  23. 23.
    Allansmith MR, Korb DR, Greiner JV, Henriquez AS, Simon MA, Finnemore VM (1977) Giant papillary conjunctivitis in contact lens wearers. Am J Ophthalmol 83:697–708CrossRefGoogle Scholar
  24. 24.
    Vasquez RJ, Linberg JV (1989) The anophthalmic socket and the prosthetic eye. A clinical and bacteriologic study. Ophthal Plast Reconstr Surg 5:277–280CrossRefGoogle Scholar

Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2019

Authors and Affiliations

  1. 1.Department of OphthalmologyUniversity of Cologne, Faculty of Medicine and University Hospital CologneCologneGermany
  2. 2.Department of Medical Informatics, Biometry and Epidemiology, Friedrich-AlexanderUniversity Erlangen-NürnbergErlangenGermany
  3. 3.Department of Ophthalmology, Ninth People’s HospitalShanghai Jiao Tong University School of MedicineShanghaiPeople’s Republic of China
  4. 4.Trester-Institute for Ocular Prosthetics and Artificial EyesCologneGermany
  5. 5.Auckland District Health BoardAucklandNew Zealand
  6. 6.School of Optometry and Vision ScienceUniversity of AucklandAucklandNew Zealand
  7. 7.Center for Integrated Oncology Aachen-Bonn-Cologne-DuesseldorfCologneGermany

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