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Enucleation Editorial Tips for Fitting Eye Prostheses for the Pediatric Patient After Enucleation Pascale Scuflaire Ocularistes Associés, Brussels, Belgium Abstract After 20 years of making custom ocular prosthetics in Belgium together with several ophthalmologists, I wrote this article to share my experience, challenges, and solutions for fitting the pediatric patient after enucleation. Pediatric fitting is not something that can be improvised on the spot, and to avoid mistakes in the psychologic approach to the child and parents, a thorough understanding of the scientific literature is clearly essential. Familiarity with the anatomical development of the eye is especially important as, with this knowledge, the ocularist is better able to create a realistic result when designing the iris and scleral segments of ocular prostheses for babies and young children. Keywords New body image, impression of the socket, prosthetic replication technique, bi- or plano-convex iris button, create the effect of changing pupil size of the prosthesis, close and early collaboration Disclosure: Pascale Scuflaire has nothing to declare in relation to this article. No funding was received in the publication of this article. This article is a short opinion piece and has not been submitted to external peer reviewers. Open Access: This article is published under the Creative Commons Attribution Noncommercial License, which permits any noncommercial use, distribution, adaptation, and reproduction provided the original author(s) and source are given appropriate credit. Received: April 11, 2015 Published Online: March 8, 2016 Citation: US Ophthalmic Review, 2016;9(1):49–52 Correspondence: Pascale Scuflaire, New Ocularistes Associés, 146 blvd Brand Whitlock, B-1200 Brussels, Belgium. E: Iso.2@skynet.be Psychologic support is one of the most important parts of the fitting procedure and should not be taken lightly. Announcing to the parents that their child has a retinoblastoma is always an unbearable situation. It conjures up extreme feelings of guilt, stress, and fear in the parents and the child. Can you imagine finding out that your long-awaited child, the perfect blank slate on which you projected all your hopes and dreams, has turned out to be a "sick" baby? The shock will be all the more terrible when enucleation is the only possible solution. The news is absolutely devastating. The process of accepting the disease and grieving for the loss of the "perfect child" is essential for the physical and mental development of the child. 1 Parents who refuse to accept the reality of the situation are in denial and will have great difficulty accepting the "new image" of their child with her/his prosthetic eye. The prosthesis will never be "perfect" enough for them, and the child will end up internalizing the negative image reflected back at him/her as a result. 2 The future of this child—who is usually too young to understand the disease and its consequences—depends on his/her parents’ acceptance of the situation and readiness to make plans for their child’s future. 2 Our role is to help the child rebuild his/her sense of self around a new body image and the image s/he projects to others. TOU CH MED ICA L MEDIA The first step to a successful fitting procedure begins with the first appointment. Ideally, the first consultation should be 4–6 weeks after the enucleation. By starting the fitting procedure early, we not only increase the likelihood of good esthetic results, but also support the positive psychosocial development of the child. At the first appointment, it is important to understand the dynamics of the parent–child relationship. This will helps us develop a better connection with the child and earn his/her trust. In 2008, the findings of French ophthalmology research 3 highlighted the psychologic, ethical, and social impact of this first appointment. It demonstrated the importance of providing the child with age-appropriate information about the fitting procedure and working with the parents to accept and reiterate the information given to their child. If you are sensitive to the situation and take the right approach from the beginning by explaining the prosthetic fitting procedure and its limits, it will help to eliminate any anxiety the child and/or the parents may feel in the future. At this first appointment, if possible, the postoperative conformer should be replaced by a temporary aesthetic ocular prosthesis. This temporary prosthesis not only serves to hold the conjunctiva in place and re-educate the eyelids, but also changes the child’s appearance for the first time after the enucleation surgery. This is the first step on the path to accepting the ocular prosthesis. 49