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Mon Nov 26, 2012 1:36 pm

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My brother-in-law had enucleation of a painful blind eye in September. He had some pain initially which did settle down.
He was in very hot, dry conditions a few weeks back and had some bleeding from the socket which cleared up (Not sure what treatment he had), and the bleeding and pain stopped.
Last week, he suddenly developed more severe pain in the socket, not as bad as pre-op, but worse than he has had since the op.
He went to see the specialist who told him he didn't know why he was experiencing this pain, and is scheduled to go back to them in 2 days when they will remove the temp implant and have a look in the socket. He has no faith in them whatsoever and is extremely worried. As much info as we can give him before he goes will be helpful.
1. Is this pain something that will settle?
2. Is it okay for them to remove the implant and leave it out until the socket settles, or will the socket shrink very quickly?
3. Is there anything he can do in the meantime to ease the pain?

My instinct is that he maybe has a dry socket and possibly the implant is irritating the optic nerve. Maybe if they take it out and give everything a good clean, that may help?

As I say, the care that he has had has been pretty poor. If it was feasible, we would bring him to the UK to be seen at Moorfields again, but we can't just keep doing this. Cost last time was more than £3000.
Any info that anyone can give will be most gratefully received.



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Mon Nov 26, 2012 2:59 pm

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Sorry, I replied to your other thread first. All the info is on this thread. I'm not up on the aftercare of his eye removal, but 2 months post op seems a long time to still have a temp implant. I'm sure you will get more definitive answers in a bit.
Good Luck.

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Mon Nov 26, 2012 3:05 pm

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Hi. He only came over to the UK for a week or so and had lots of tests done at Moorfields. Went back to his own country and had intraocular injections done but eventually got a very apinful, infected eye and had enucleation.
He had the temp implant put in, but then a few weeks later was out of the country for a month and has returned a week ago with this pain. Where he was, was extremely hot and dry (maybe 50 degrees) so whether that has a bearing.



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Mon Nov 26, 2012 4:27 pm

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I've never heard of a temporary implant, only a temporary prosthesis and a conformer. On this side of the pond, the "implant" is put in at surgery and intended to be permanent. I can't give advice other than to say that if the pain is that severe, I'd be getting in to see someone quickly.

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Mon Nov 26, 2012 11:54 pm

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stretchaz wrote:
I've never heard of a temporary implant, ... if the pain is that severe, I'd be getting in to see someone quickly.

I'll agree with Stretch.
First, there's often miscommunication when we hear about issues secondhand. Can you convince your Brother-in-law to "talk" to us directly?

Second, about the questions you pose:
1) Pain is the way your body says, "things aren't right." Its length of time & severity depend in the treatment necessary to remove its cause,
2) We mentioned some confusion about terminology. Just a guess would be that an empty socket will not close in empty a reasonable amount of time. You should ask his physician, and
3) No one should suffer agonizing pain. Suggest that he make the severity of the pain clear to the physician.

I wish I could offer better answers. Please let us know how the situation is developing.

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Tue Nov 27, 2012 10:56 am

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Sorry guys. It was just my terminology that was wrong. It'll be the conformer (the temp thing that holds the shape of the socket?) that he has. Not an implant. I just didn't know the right word for it :?
He can't talk to you directly as he doesn't speak English.
I honestly can't understand what his doctor is at! He told him to come back in 2 days so they could have a look!! Surely, he should have removed the conformer then and there and examined the socket. Unfortunately, one of the biggest problems is that in his country (Algeria) doctors don't seem to think that people need information. It's ridiculous. Makes me mad.
He got more help here in the UK from the brilliant doctors at Moorfields than in all the times when he had been seen in his own country. Everything was explained, all questions answered and they have been amazing even since then, when I emailed them pre-op about the surgery etc.
I think we are hoping that there is a simple reason for the pain he is now experiencing, something that can be helped, and that he isn't left with forever.



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Tue Nov 27, 2012 3:47 pm

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rosie383 wrote:
Sorry guys. It was just my terminology that was wrong. It'll be the conformer (the temp thing that holds the shape of the socket?) that he has. Not an implant. I just didn't know the right word for it :?
He can't talk to you directly as he doesn't speak English.
I honestly can't understand what his doctor is at! He told him to come back in 2 days so they could have a look!! Surely, he should have removed the conformer then and there and examined the socket. Unfortunately, one of the biggest problems is that in his country (Algeria) doctors don't seem to think that people need information. It's ridiculous. Makes me mad.
He got more help here in the UK from the brilliant doctors at Moorfields than in all the times when he had been seen in his own country. Everything was explained, all questions answered and they have been amazing even since then, when I emailed them pre-op about the surgery etc.
I think we are hoping that there is a simple reason for the pain he is now experiencing, something that can be helped, and that he isn't left with forever.



The conformer is more of a place holder for the prosthesis. They will need to take it out to check and see what's happening. but it is likely not the cause of the discomfort in the socket. They can put it right back in, too. I don't know why they didn't take it out and have a look when he was there before. It's not good to leave the conformer out for a long time (just how long one can do it I'm not sure) because then it is difficult to fit the prosthesis that comes later. The implant which I assume was put in at surgery is the main place holder for the socket. He needs to find out the source of the pain, hopefully they can sort that out.

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Congenital cataract & strabmismus/amblyopia right eye; no useful vision
Detached retina 2009, right eye; evisceration March 2010



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Tue Nov 27, 2012 6:51 pm

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Further to the earlier reply..... does anyone know how long it is okay to leave the conformer out? A day or two? I'm hoping that they can find the source of the problem for the poor guy and that there is an easy solution.



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Tue Nov 27, 2012 10:36 pm

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rosie383 wrote:
Further to the earlier reply..... does anyone know how long it is okay to leave the conformer out? A day or two? I'm hoping that they can find the source of the problem for the poor guy and that there is an easy solution.


A day or two shouldn't matter, but the conformer being out is not likely to change his symptoms, if the pain is in the socket. The doctor would remove it to check the socket and put it back in. I don't think there's any reason to leave the conformer out otherwise.

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Congenital cataract & strabmismus/amblyopia right eye; no useful vision
Detached retina 2009, right eye; evisceration March 2010



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Wed Nov 28, 2012 4:47 am

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Hi Rosie; sorry to hear about your BIL; i agree 2-3 days with conformer out is ok; but a conformer which is like a full contact lens does not cause pain. I'd be thinking that maybe the implant is being rejected or exposed????? Run it past Moorfields; a few here have had small tears in the skin covering the implant or complete exposure. I'm sorry he's not in a better country with excellent health facilities. cheers vera

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Wed Nov 28, 2012 6:43 am

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Thank you. Vera, what does it mean that the implant could be 'exposed'? Actually, I'm going to go and have another hunt around and see if I can understand the process following enucleation. Even though I was a nurse for over 20 yrs, I have no clue here and can't visualise what you are talking about.



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Wed Nov 28, 2012 7:03 am

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Okay. I am kicking myself now!!! Managed to find a site which had diagrams of what is involved so now I getcha!!
Soooooo, they will pop out the conformer and have a look at what is going on with the implant, but not necessarily open it up again. I understand now what you mean about the possibility of the implant being exposed Vera.



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Wed Nov 28, 2012 9:48 am

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Ok Rosie; during the op the eye muscle is slit and the implant inserted then the slit is stitched to keep the implant in. I could be the healing stitches or what I mentioned; anyway as I said Moorfields will help; maybe they can skype through to his doc in his homeland. I wish you both a good outcome. Cheers vera

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Wed Nov 28, 2012 7:24 pm

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rosie383 wrote:
...Managed to find a site which had diagrams of what is involved so now I getcha!!
....

When you find the opportunity, Rosie, post the URL of that site you discovered. It might be useful in future discussions :)

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Thu Nov 29, 2012 6:57 pm

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Here you go. :)

http://artificialeyes.net/adjusting-to- ... operation/

My husband spoke to his brother yesterday and they think there could be inflammation actually around the implant itself so they are planning to open it up and have a look. Sounds from what you guys are saying that it could be rejection maybe? Apparently the whole area around the eye is swollen now. Poor guy. After the initial surgery he went hypo (he has recently been diagnosed as diabetic), collapsed and was in really bad shape. So he is terrified of the same thing happening. Does anyone know if they are likely to remove the implant under local or general anaesthetic? He is going to have to travel about 400 miles to the only half-decent clinic where he was treated before. Hopefully they will know what they are doing. As for the docs setting up a skype conference with the docs at Moorfields.... it is a good suggestion, but I'm not sure that the consultant at Moorfields would be so generous with his time. He has been so good since he saw my BIL and has reviewed various scans that we have emailed to him and replied to email queries, but as my BIL was seen as a private patient (at considerable expense) I'm not sure I can ask them for any more 'free' help!



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Fri Nov 30, 2012 5:36 am

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Hi Rosie; give it a go anyway; I've been surprised at the genuosity of some medical people Some occularists will make your eye and let you pay it off over months if you can't pay up front. I think they will not know anything until they go in .... and find what is wrong; then take it from there. Hopefully a general .......... I wish him well. cheers vera

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Wed Dec 05, 2012 7:43 am

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Let it snow! Let it snow! Let it snow!

Beautiful here this morning! kids will be so excited when I wake them this morning for school :D

Wee update on my BIL. He went back to see a doctor as he had a lot of swelling and inflammation. They gave him a course of antibiotics and some type of drops/ ointment. The pain and swelling has gone completely thank goodness.

He will travel next week to the clinic to be properly assessed. Again, thank you to all who have taken the trouble to reply.



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Sat Dec 08, 2012 12:34 am

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Hi Rosie; great news; another thing is you can do an ultrasound on the eye to see what is happening before going back in ......... guessing though that where he lives might not have the machine ..... snow ............... a fond memory only for me; been in OZ 30 yrs and saw it for the first time 2 yrs ago ........... a long way to go for a toboggan ride but great fun. cheers vera

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Wed Dec 19, 2012 6:35 pm

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Hi all.
Needing your advice again please. My BIL ended up with a very swollen, nasty eye area. His Doc gave him antibiotics which helped until he could get to the clinic he needed to go to.

He got there yesterday and they had to remove the implant and apparently they had to remove all the 'tissue' which was there after the enucleation. Now, I think that they have had to take away the muscles etc as they were very inflamed and possibly necrotic, but we have asked the family to send us the report so that we get a better idea.
The doc told him that he is now left with a completely empty socket and that he can't get a normal prosthetic eye, but will need something that fills the whole socket. Does that sound about right?
We will probably bring him to the UK as he can't get it done in his own country. I want to ask the right questions once I approach the guys at Moorfields.



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Wed Dec 19, 2012 11:11 pm

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rosie383 wrote:
... they had to remove the implant and apparently they had to remove all the 'tissue' which was there after the enucleation. Now, I think that they have had to take away the muscles etc as they were very inflamed and possibly necrotic, but we have asked the family to send us the report so that we get a better idea.
The doc told him that he is now left with a completely empty socket and that he can't get a normal prosthetic eye, but will need something that fills the whole socket....

Rosie, there are 3 basic types of surgery to remove the eye. The first listed below is more a partial removal, the second what your BIL has apparently already undergone and the third may be a bit more radical than his latest surgery.
Quote:
1) Evisceration is the removal of the contents of the globe while leaving the sclera and extraocular muscles intact.

2) Enucleation is the removal of the eye from the orbit while preserving all other orbital structures.

3)Exenteration is the most radical of the three procedures and involves removal of the eye, adnexa, and part of the bony orbit.


And certainly you'll want a full report before you can know exactly what he's going to face.

Oculoplastic surgery has come a long, long way in recent times and so has the art of prosthetics. Appliances now work cosmetic wonders. He likely will have no movement and might want to consider alternatives that hide the eye such as a patch or dark glasses.

I favor wearing a patch most of the time but keeping a prosthesis in the socket so I can unveil the "eye" at the barber shop, swimming and other activities with which a patch might not be compatible.

The bottom line is: He's apparently got that horrid infection on the run and his prospects for a satisfactory cosmetic sound quite favorable from what you've stated. Thanks so much for the update. I'm sure others more knowledgeable than I will weigh in directly. :thumbs:

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