A survey of prosthetic eye wearers to investigate mucoid discharge

BACKGROUND This study aimed to better understand the causes and treatments of mucoid discharge associated with prosthetic eye wear by reviewing the literature and surveying anophthalmic patients. METHODS An anonymous questionnaire was completed by 429 prosthetic eye wearers who used visual analog scales to self-measure their discharge experience for four discharge characteristics: frequency, color, volume, and viscosity. These characteristics were analyzed with age, ethnicity, years wearing a prosthesis, eye loss cause, removal and cleaning regimes, hand-washing behavior, age of current prosthesis, and professional repolishing regimes as explanatory variables. Eighteen ocularists' Web sites containing comments on the cause and treatment of discharge were surveyed. RESULTS Associations were found between discharge frequency and cleaning regimes with more frequent cleaning accompanying more frequent discharge. Color was associated with years of wearing and age, with more years of wearing and older people having less colored discharge. Volume was associated with cleaning regimes with more frequent cleaners having more volume. Viscosity was associated with cleaning regimes and years of wearing with more frequent cleaning and shorter wearing time accompanying more viscous discharge. No associations were found between discharge characteristics and ethnicity, eye loss cause, hand washing, age of current prosthesis, or repolishing regimes. Forty-seven percent of ocularists' Web sites advised that discharge was caused by surface deposits on the prosthesis, 29% by excessive handling of the prosthesis, and 24% by other causes. CONCLUSIONS A standardized treatment protocol for managing discharge is lacking. More frequent prosthesis removal and cleaning was associated with more severe discharge, but the direction of cause and effect has not been established. Professional repolishing regimes had limited impact on discharge experience. Further research into the socket's response to prosthetic eye wear, including the physical, chemical, and biological elements of the conjunctiva, the socket fluids, and the deposits that cover the prosthetic eye is recommended.