Winter 2008
Child Life
Going to the Ocularist
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Going to the Ocularist.
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Timothy Murray MD
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What's Happening?
When going to the ocularist, your child’s greatest fear will be that they will experience severe pain in the fitting of their new eye. This will not happen, although the child will feel some very weird (though not painful) sensations. The problem is that, psychologically, children and adults are not accustomed to somebody sticking something into their eye
Children can, and will with time, overcome these fears and anxieties. A parent can assist a child in overcoming these fears by reminding them that there is nothing in the socket that can be harmed. Be careful not to use words like hurt and pain, even when explaining that the procedure will not hurt. All the child will hear is HURT. Shift wording from pain and painful terms to discomfort.
Describing sensations using humorous sensory based words will help explain the feelings they may experience. For example, “the ocularist will use some special squishy clay/playdough to make a special mold of inside your eye socket”. It is so important to stress that it will feel weird or funny, but that Mom/Dad will be there to help the child and the ocularist finish up as quickly as possible.
Sometimes children benefit from positions of comfort for this procedure. Sitting on a parent’s lap may provide much needed support for a child. Give your child the choice of sitting on Mom/Dad’s lap or sitting on the special chair on their own. Supportive directions to breathe deep are appropriate during any medical appointment.
In the first step of the eye making process, the ocularist will place a special "plunger" into the child’s eye socket. The plunger looks very much like a suction-cup arrow that are found on children’s toys. The child will not feel the plunger in their eye, but they will have a weird sensation because their eyelid is resting on the portion that is sticking out. This doesn't physically hurt, but psychologically it seems very weird – not a sensation a child normally experiences. It takes a few seconds to get used to, but if well supported, a child will do so as soon as they realize that it doesn't hurt, it just feels weird.
Next, the ocularist will insert some plastic-like materials through the plunger into the eye socket (see picture 2 above). This doesn't hurt either, but it also feels weird. The child must sit for a couple of minutes while the plastic-like materials harden. Then, when the ocularist removes the plunger and mold, the sensation is gone.
Psychologically, this portion is the most difficult part, not because it hurts, but just because it is so unfamiliar and foreign from anything a child has experienced before. This entire process should take about 5 minutes.
Parents can better support their child through this process by using language that conveys support, hope, love, courage and affection. This will help your child let go of fear and discomfort. What you say and how you say it reflects what you think and feel. Finding appropriate ways to reduce your own fear and anxiety BEFORE this procedure starts is important.
Some children need support and assistance to feel and experience each aspect of the procedure, while others might prefer to turn their attention away from the procedure. Based on your child’s preference, you can provide fun distractions away from the procedure by talking and asking questions about a favorite game, movie, TV show, story or happy memory – like a favorite vacation spot. For the child who prefers to be supported by focusing on the procedure, parents can ask appropriate questions, such as “Does the squishy stuff feel cool or warm?” or “It is clear that this feels funny to you. Can you tell me about it?” This may seem like you are focusing too much on the procedure, but this actually helps the child define the sensation and conveys the idea that they are being listened to. This also helps to compartmentalize the sensations and discomfort, and allows you, the parent, to understand the experience and provide even better verbal support.
The ocularist uses the plastic mold is create a wax impression similar to the cavity in your child’s eye. The ocularist will then take the wax impression and place it into your child’s eye to see how it feels. The child may not feel some parts of it, while other parts will cause pressure inside the eye socket. Encourage your child to tell the ocularist which parts are causing pressure, and the ocularist will take it out and make it smoother, and then reinsert it.
The ocularist will then smooth and reshape the wax so that the impression is the right shape for the eyelids to rest properly on when the eye is open, and then close properly when the eyelids blink. The ocularist is going to shape the wax so that it fills out certain areas around the eye socket to give the eye a natural look.
The ocularist may need to insert and take out the wax impression several times during this process. It is not painful, although your child’s eye socket may become a little irritated – sometimes by the in and out action and other times due to the lubricants used. Sometimes switching the lubricant to a heavier silicon lubricant can help the irritation go away.
After the ocularist has the wax impression properly fitted, the plastic insert will be made. This takes about an hour and you end up with a plain white piece of plastic the same shape as the wax. The ocularist will need to insert and remove this from the child’s eye socket several times. You can provide support to your child by explaining the steps, and the reasons for these steps. For example, “The ocularist is fixing the shape to make sure it is comfortable and to check that your eyelids can open and close properly”. The plastic an ocularist uses is completely smooth and very tough!
After you, your child and the ocularist are satisfied with the shape of the insert, and how the eyelids rest; the ocularist will take a few seconds to draw on the insert how the eye hole should be aligned.
In the next step, the ocularist will drill the eye hole in the plastic, and insert the colored area. This starts with something resembling a button, which is very close to your child’s own eye colour. It fits over and around the hole which the ocularist has created.
Your ocularist may ask your child to sit next to them as they paint the special eye, looking closely at your child’s remaining eye as a guide. Sometimes ocularists use a photo of a child’s eye to reduce the amount of time a child needs to remain in the office. The painting process is very interesting. For instance the small red veins in your eye are duplicated by taking small strands of fabric and carefully placing them on the plastic. Some children want to see how this is done. When completed, the new eye will resemble your child’s remaining eye.
There is a final fitting, and then your child is done!
The new eye will look and act very similar to your child’s remaining eye. Sometimes there may be a slight variation in how the eyelids rest. If there is significant variation in how the eyelids rest, you may want to consult with your child’s ocularist about making some slight alterations so that it blends better.
Painful no, uncomfortable and strange yes, tiring yes, but at the end of the process, a beautiful new eye.
by The Eye Guys in Denver, Colorado.
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