In 1818 Hazard-Mirault wrote that many ophthalmologists were unwilling to risk the surgical enucleation necessary to prepare a socket to facilitate the insertion of an ocular prosthesis. The surgeons thought, perhaps with some cause, that they were sparing their patients misery. In the later 19th century, with anaesthesia and antisepsis, enucleation of the orbit became more common. Artificial eyes had to change because previously most ocular prostheses had been intended to cover an atrophied eye.
In 1900 Pache & Son of Birmingham were makers to the principal hospitals in the United Kingdom and could provide Snellen’s improved ‘reform eye’ a double shell that prevented a sunken appearance.
Millauro was thus pointing out that senior surgical practitioners had a self-interest in ensuring that the work of the technician was of the highest order!
One benefit of eyes supplied from stock, that still applies today, is that they can be good for children who will undergo normal growth (tissue change within the orbit) thereby wasting money spent on custom-made prostheses. Nevertheless developments in material science have made the custom-made eye the more prevalent. Changes in glass-making technology and the invention of new acrylics have been crucial in affecting the practices and training of the modern ocularist. During World War Two a shortage of German (Lauscha) glass led the British and the Americans to investigate techniques for the use of acrylic. The US Government’s involvement in partnership with manufacturing firms including one led by Paul Gougelmann, was notable. Research was carried on in parallel on both sides of the Atlantic. Royal Navy dental technicians were probably the first to use plastic in 1941. Meanwhile Fritz W. Jardon (in Southfield, MI) in conjunction with the American Optical Co and the US Army and Navy Dentist perfected Methyl-Methacrylate resin.
The Monoplex eye by American Optical was a noted acrylic prosthesis of the 1950s and 1960s. Fitting sets containing 120 examples were supplied to practitioners. The use of steel dies at the factory meant that the same shapes could be produced time and time again. Three of the most common shapes are shown in the illustration: Oval, standard and three-cornered. The eye was adaptable for all types of patients. For instance hand colouring with liquid plastic pigment could take into account different racial skin colours. In 1960 the company produced a patient guide. Its advice included wearing spectacles to divert attention away from the artificial eye and turning your whole head rather than your eyes when looking at something. The same eye could have plastic added to it so that it grew with the patient and was designed to be worn continuously, day and night for prolonged periods.
In the United Kingdom the supply of artificial eyes was included within the National Health Service from 1948. A National Artificial Eye Service (NAES) with its administrative and manufacturing headquarters in Blackpool was established over the next few decades as a direct successor to the prosthetic department of the Army Spectacle Depot, the difference being that state supply was no longer restricted to serving personnel or war pensioners. The NAES developed a system whereby teams of skilled technicians took the wax models and specifications provided by Eye Fitters (Orbital Prosthetists) and turned them into a prosthesis to match the patient’s natural eye, whenever such an eye was present to copy. As of the year 2000 the NAES had 16 centres staffed by Eye Fitters and a network of 54 outreach clinics nationwide to which the Eye Fitters would travel. Artificial eyes were also manufactured for patients in Wales, Scotland, and Northern Ireland who had their own fitting services.