The Art and Science of Prosthetic Eyes: A Glimpse into the World of Ocularistry

The process of creating a prosthetic eye is intricate and highly personalised because, as Mr Morphett explained, “Each patient is treated differently, individually.”

Every step of the process is handled within his laboratory. The journey begins with taking an impression of the eye socket using a specialised moulding material. From this, a plaster cast is created, forming the foundation for the custom-fit prosthesis.

The materials used are carefully selected for their durability and biocompatibility and Mr Morphett insists on a long, slow curing process to ensure excess monomer is leeched out and there’s no porosity in the prosthetic.

This painting process is where Mr Morphett’s artistic skills truly shine. To create a lifelike appearance that closely matches the patient’s natural eye, he uses a combination of artists’ oil paints, which are mixed with a liquid acrylic.

He paints with the patient sitting in the chair beside him. “We paint a little disc that corresponds to the size of the patient’s eye, building from black, and putting some detail in with white. Then we add colours or colour washes over the top to get the finish that we need,” he explained. He adds subtle touches like veining and a carefully crafted limbus to enhance realism.

“So we paint in layers and then we insert the disc into a prosthetic or shell before being cured.”

Attention to detail is paramount because “we don’t want people to notice our work. It’s one of those odd jobs, we don’t want people to notice what we do”.

“My aim is to create an eye that looks just like the patient’s healthy eye. Often it will only be the patient’s partner or immediate family that will be able to identify the difference,” he said.

And while painting the eye is intricate, Mr Morphett said the most challenging aspect of the job is getting the fit right so that it is comfortable for the patient to wear and does not rub on the conjunctiva covering the surgical implant. In most cases, if the technique is good enough, the patient’s prosthetic eye will achieve 90–95% of its original movement.

Such is the realism achieved by Australia’s ocularists that the “accepted rule is about one in every 800–900 people in this country is likely to be wearing a prosthetic or cosmetic shell”. We simply don’t notice.

… for Mr Morphett, helping children who have been born with a birth defect or had their eye removed because of a retinoblastoma is by far the most satisfying aspect of his work…

Driving Force

The journey to becoming an ocularist was an unexpected one for Mr Morphett. He began his career in contact lenses, gradually transitioning to artificial eyes due to demand from local hospitals. “We were working with OPSM, creating shells to sit over damaged eyes in the contact lens department. And, under pressure from the Sydney Eye Hospital, which was just across the road, I progressed from there to doing artificial eyes,” he recalled.

Mr Morphett established his own clinic in Sydney and went on to become the first ocularist to establish clinics outside the CBD to service regional and rural areas. These days, he has clinics in Sydney and Parramatta, in Canberra, and in the New South Wales regional centres of Orange and Newcastle. Additionally, he is the founder of the Australian Association of Ocularists.

The ability to make a significant difference in any person’s life, restoring not just their appearance but often their confidence and social interactions, is clearly a driving force for Mr Morphett.

“I had a patient in Orange with a damaged eye – it was small and opaque in colour. For years he’d been told nothing could be done about it and he’d become pretty introverted. We fitted him with a shell, and it changed his life socially. Another patient, a young woman in western Sydney in her late teens, came to me having had an enucleation due to a tumour as a young girl. She had this tiny little socket and so the only prosthesis we could ft was tiny. But then we got a dispenser to fiddle around with a pair of glasses which made the prosthesis look a little bit bigger and a bit more normal in shape. That week her mother rang to tell me my patient hadn’t been home before two o’clock in the morning all week. I said, ‘What are you telling me that for?’. And she said, ‘I wanted to thank you. She’s finally going out.’” She felt she looked reasonable and so she went out and started to enjoy herself.

However, for Mr Morphett, helping children who have been born with a birth defect or had their eye removed because of a retinoblastoma is by far the most satisfying aspect of his work, although it comes with a unique set of challenges.

His approach is one of patience and understanding, recognising the emotional stress that patients and their families are under. “Some days you go home, and you’ve been kicked and screamed at all day long. And that’s just the parents,” he joked, highlighting the importance of maintaining a sense of humour in difficult situations.

Mr Morphett acknowledged the unique skill set required for his profession. “It’s a strange skill set you’ve got to have. You’ve got to be technically attentive and meticulous, but you’ve also got to be able to talk to people. Generally, those two don’t go together,” he observed.

… some ocularists are experimenting with digital irises, however in his opinion the level of detail is not good enough yet to match a hand-painted disc.

Evolving Techniques

The field of ocularistry is constantly evolving, and Mr Morphett said the Australian and global ocularist community is constantly trying new techniques and sharing ideas they hope will result in better patient outcomes.

One technique he has been working on is to constantly build on the size of a child’s prosthesis (in between replacing the eye every 12–18 months) so that their eye socket grows in line with their natural eye. Aside from aesthetics, that’s important because “you want to do everything possible for them now to ensure they’re able to take advantage of any new technologies in the future”.

He said some ocularists are experimenting with digital irises, however in his opinion the level of detail is not good enough yet to match a hand-painted disc.

What has made the most significant difference to outcomes is modern surgical techniques.

“It used to be that general eye doctors would remove a patient’s eye. Now they tend to refer on to ophthalmologists who specialise in ocularplastics. They can do more with the eyelids to improve cosmesis and functionality.

Quite often a patient will end up with a droopy eye lid after a long period of wearing an artificial eye. Or as they get older, their bottom lid gets a bit slacker. Ocularplastic specialists can repair these changes, which is good for the patient and it makes my job a hell of a lot easier too,” Mr Morphett said.

Looking to the future, Mr Morphett is focused on passing on his knowledge and skills to the next generation of ocularists. His associate, Alice Grimsdell, originally a dental prosthetist, is being trained in both the manufacturing and consulting aspects of the ocularist profession, ensuring that this specialised skill set continues to be available to those who need it.