Case One

a You are asked to look at this patient and decide on further  examination. What abnormality can you observe? Answer The patient has a left exotropia and the left eye has  abnormal reflection (note the smooth appearance of  the eye white). The appearance suggests that the left eye contains a prosthesis. You may want to shine light on the eyes to show that the left pupil does not react to light and at the same  time accentuate the differences in reflection from the eyes. The next step is to ask the patient to remove the prosthesis in order to find out if it is a scleral contact lens or a prosthetic shell. See picture below for more pictures.   a a Cosmetic scleral contact lens from the patient's left eye. Left unsightly eye following removal of the scleral contact lens. Return to observation II