Doctor's Review: Medicine on the Move

October 23, 2017
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An eye for an eye

Back in the day, ocular prosthetics ranged from the regal to the rudimentary

As Charles Dickens so plainly pointed out in his description of the nasty schoolmaster Wackford Squeers in Nicholas Nickelby, “He had but one eye and the pocket of prejudice runs in favour of two.” Indeed, those hapless one-eyed patients of the past — whether they came upon their ocular singularity by birthright, illness or violence — faced serious adversity, from pain and infection to public revulsion and prejudice.

The grotesque caricature of the villainous, one-eyed man did not originate in Mr. Squeers, however; the ancient mythical race of Cyclopes appearing in Homer’s Odyssey can likely lay claim to that dubious distinction. However, unlike those overly muscled one-eyed giants known for forging Zeus’ thunderbolts, having one eye was not a particularly powerful proposition for most people. Their choices were few: either leave the hole open and perhaps patch it, have the socket sewn shut to cover whatever unsightliness remained, or plug in a false eye... the best option, perhaps, though one often reserved for those who could afford it.

Seeing gold

Of course, affording some of the earliest artificial eyes was probably not much of a problem since they were fashioned out of ordinary clay or metal then painted to resemble real eyes. The Ancient Egyptians, Greeks and Romans devised various versions of these external representations, which were attached to cloth and worn over the eyelid as a patch. The Egyptian dead deserved better, apparently: examples of artificial eyes made from bronze have been discovered on the death masks of mummies dating as far back as 2000 BCE, presumably in the hopes of ensuring everlasting vision for the departed.

While Roman statues often contained eyeballs made of precious metals and stones, the first literary mention of an artificial eyeball being placed internally in a living person comes many centuries later in the works of the famous French surgeon Ambroise Paré (1510-1590). Paré, known for his theatrical amputations and medical antics on the battlefield, devised many prostheses to replace the blown-off noses, digits and legs of injured citizens and soldiers. Because enucleation — the surgical removal of the eyeball — was rare until the 19th century, Paré developed two forms of false eyes: the “ekblephara” worn over the eyelid and the “hypoblephara,” a hemispherical cup worn under the eyelid over the existing damaged eyeball. The materials used were primarily silver and gold.

Interestingly, there is one example of an internally worn artificial eye that predates all. In 2006, an archeological dig along the Iran-Afghan border revealed what is doubtlessly the first false eyeball known to exist. At more than 5000 years old, its lucky owner was likely a priestess of some sort. Her prosthetic — a 2.5-centimetre wide cup fashioned out of bitumen paste and covered in gold — was complete with an imprint of an iris adorned with sun-like rays emanating from its centre. Evidence shows it to have been held in place with thread, the impressions of which remain on her inner eyelid. The ancient Persian prophetess was out of the ordinary in other ways too: she stood more than 1.8 metres high — far taller than her contemporaries.

Looking glass

The earliest mention of glass eyes appears in 1606, in Act IV, Scene 6 of King Lear: “Get thee glass eyes / And, like a scurvy politician seem / To see the things thou dost not” (King Lear to the Earl of Gloucester). Even then, however, it seems that they were a relatively recent innovation.

The first known professional ocularists came out of Venice in the late 16th century. No surprise since they were a product of the golden age of Italian glassmaking. These early glass eyes were likely extremely uncomfortable, despite their beauty and relative realism, since, in order to make them shatterproof, they needed to be heavy. Regardless, they were highly sought after and Venetian glass eyes remained in demand until the 1800s.

By the 19th century, eye making had become an art in Europe with some of the best craftsmen working in France and Germany. In the 1820s, enamel became the go-to material. Though enamel eyes were heavy and fragile, they were popular for over 50 years. Overall, the glass and enamel eyes of the 19th century were impressive, yet expensive. Families of master eyeball-makers would pass the secrets of their skills down through the generations.

In 1835, German eyeball-makers finally created a lightweight, hollow glass eye following the invention of a vaguely eyeball-coloured form of glass called cryolite. The eyeball was even painted with an iris. These falsies would become the gold standard for the next 100 years. If the eye is the jewel of the body, as Henry David Thoreau put it, then the glass-eye-blowers of 19th-century Germany were surely the jewellers to turn to when circumstance demanded it.

Of orbs and ornaments

Although the new glass eyes were indeed breakable, they were fare more lightweight and in turn comfortable than their predecessors. Despite the fact that abrupt temperature changes would sometimes cause these eyes to suddenly explode, as could the thin glass’ constant exposure to the weakening effects of body acids, those in need clamoured for finely made German glass eyes. In fact, the town of Lausche became a well-known centre for glass prosthetics, as well as doll-eyes and holiday ornaments.

These pioneering German ocularists — who acted for all intents and purposes as early ophthalmologists, minus the medical degrees — quickly realized that the market was immense and brought their services on the road, travelling the European countryside and taking orders along the way. Eventually, they found their way to North America, where they would set up eye-making shops for a few days, craft eyeballs to order, then head to the next town to do the same. The American eye-making movement only came into its own when World War II started, with the public growing increasingly leery of all things German.

Fantastic plastic

The first phase of American ingenuity was the mass-production of glass eyes. Anyone in need could, at that time, simply visit an ocularist who would pull out a box and look for the best fit from a collection of so-called “stock eyes.” Alternatively, one could order an eyeball through the mail. Although access was greatly improved, the problems of glass were still largely unresolved until an Army and Navy dental technician named Fritz Jardon came along.

What began as a military initiative to help resolve the common battlefield injury of eye loss became a revolution in ocular prosthetics. Jardon was familiar with the new wave of medical plastics being used the field of dentistry, and with the backing of the American Optical Company, began to rethink fake eyeballs with veterans in mind. Experimenting with cutting-edge plastics, acrylics and resins, he created a completely new version of the artificial eye.

These materials, unlike glass, were durable, inexpensive and readily available. More importantly, they were malleable and could be shaped to conform to socket impressions. Also, while a glass eyeball would last a year, maybe two, a plastic one had a much longer lifespan. It could also be cleaned and polished. As an added bonus, they could approximate a far more natural likeness of a real eyeball, reducing stigma and embarrassment for the patient.

For safety’s and comfort’s sake, it was soon discovered that plastic orbs could be attached in a way that glass eyes could never be: metal pegs! For this reason, acrylics (in particular, methacrylate resin) remain the material of choice in artificial eyemaking to this day. Some people, however, still prefer a good old-fashioned glass eye. To accommodate purists, glass eyes continue to be made of cryolite in Germany, in much the same way as they were in centuries gone by.

It was another literary notable, John Milton, himself completely blind by age 43, who famously stated “It is not miserable to be blind; it is miserable to be incapable of enduring blindness.” Indeed, for those in need of a fake eye, the evolving art and science of ocular prosthetics continue to make the best of an unfortunate situation.

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