Cosmetic Appearance After Eye Loss: The Role of Prosthesis Motility and Eyelid Function

Background/Objectives: We aimed to clarify which clinical and prosthetic features are most strongly associated with cosmetic appearance after eye loss.

Methods

This prospective cross-sectional study included 107 patients with unilateral anophthalmia wearing acrylic prostheses. Examiner-rated cosmetic outcomes-eyelid symmetry, orbital fullness, prosthesis recognizability, and overall appearance-were graded by three independent raters. Candidate predictors associated in univariate analysis (p ≤ 0.10) were entered into blockwise multivariable regression across four domains: clinical background, socket and eyelid anatomy, prosthesis alignment and motility, and prosthesis dimensions.

Results

Levator function (β = 0.19, p = 0.02) and prosthesis motility (β = 0.68, p < 0.001) predicted eyelid symmetry (R2 = 0.61). Orbital fullness was predicted by relative exophthalmometry (β = 0.27, p = 0.039) and motility (β = 0.34, p = 0.002; R2 = 0.34). Recognizability was predicted by motility (β = 0.55, p < 0.001) and history of additional periocular surgery (β = -0.22, p = 0.008; R2 = 0.46). General appearance was predicted by lagophthalmos (β = -0.38, p < 0.001) and motility (β = 0.35, p < 0.001; R2 = 0.69). Prosthesis dimensions were not independently associated with any of the outcomes.