The taking of an impression – phase one of the process of making an artificial eye – is slightly uncomfortable for anyone. For one thing, the paste syringed into the socket is cold. And as it sets, the sensation is quite odd to say the least.
For kids, taking an impression can be a scary experience. Imagine it from their point of view. They see us approaching with a syringe full of green paste. While we explain that it is only a syringe and there is no needle the sight of the syringe conjures images of pain and torture.
Even the good kids who try their hardest, sit still and let us inject the impression paste have the natural reaction of squeezing the eye tight shut. This pushes the paste right back out. The only way we can get a good result is for the client to be relaxed.
In the past, we’ve had a couple of options up our sleeve to tackle this problem.
If the child has a scheduled eye examination under general anaesthetic coming up, then we can do the impression at the same time. In the case where no surgery is scheduled, we’ve had to organise an anaesthetist to administer the anaesthetic while we do our work.
But no parent likes taking their child to the operating theatre, seeing him or her getting the spike in the back of the hand and being put to sleep and wheeled away. And on top of that, there’s possible reaction to the drugs afterwards and a slow recovery process.
Surgery and general anaesthetics should be a last resort and avoided where possible.
Now, there’s a much better solution for everyone.
A while back in A big thanks to Princess Margaret Hospital we described a situation involving a little girl whose conformer shell had fallen out. We couldn’t get anywhere near her to put it back in. So we made a trip to Princess Margaret Hospital’s Emergency Department. There, we were linked up with an anaesthetist who used a strawberry-scented gas to sedate her. The gas Entonox is an analgesic used to ease pain during labour, trauma and minor surgical procedures.
Its analgesic effect is strong and characterised by rapid onset and offset (i.e. it is very fast-acting and wears off very quickly).
The gas sedates the child but they do not go to sleep.
Within ten minutes, the shell had been replaced and the little girl was up and running around, all smiles.
We used this method again for the purpose of taking an impression. A young girl had an impression taken of the eye socket a year earlier while under general anaesthetic. Her parents found the General Anaesthetic distressing and the young girl took a long time to come around.
On this occasion we went to Princess Margaret Hospital where the wonderful staff in ED administered the Entonox. She accepted the mask and the strawberry-scented gas easily. The impression was quite large and therefore took a little persuasion to remove it . In her relaxed state she was not fazed by the experience. Five to ten minutes later, she was also up and running around. No side effects, no separation from her parents and no pain.
As ocularists we are not qualified to administer anaesthetics and the decision as to what form of sedation is best for the patient remains with the anaesthetist. The purpose of this blog is to inform people of their options and we encouraging people to consult a qualified doctor/anaesthetist to work out what level of sedation is appropriate for their children when undergoing this procedure.
Kids (and their parents) undergo so much when they lose an eye. They don’t need more trauma after everything they’ve been through whilst in hospital. Using this gas reduces both the physical and mental stress on everyone concerned.