Bangladesh Dental College Journal, January’ 2023; Vol-14, No.

1; p 6-11

Prevalence and consequence of customized ocular prosthesis in last 15 years at

Dhaka city, Bangladesh: A retrospective study
1 2 3 4
Islam MS, Alam MI, Hossain MI, Hossain S, Mohammad NS,5 Masud MA,6 Tamij N 7

ABSTRACT
Objective: Enucleation of eye is commonly performed as treatment modality in patients having persistent eye
defects or pathological conditions such as intraocular malignancy or loss of vision. However, clinicians all over the
world commonly offer ocular prosthesis as replacement treatment to restore the aesthetic properties of eye. The
purpose of this study is to analyze the underlying clinical etiology of eye loss in Bangladesh, in different age, sex,
and occupation groups, and measuring quality of life in patient after receiving ocular prosthesis.

Matrials and Methods: We analyzed the rate of ocular prosthesis application over the time from our record archive
in patients (n = 500) who visited our clinic from 2007 to 2022. We also compared the results within the population
in terms of age, gender, and occupation. Finally, we analyzed the socio-economic conditions and area of residence
to identify their relation in promoting ocular defects. Also, we measured satisfaction level of patients after receiving
prosthesis.

Results:Over the years application of ocular prosthesis gradually increased in Bangladesh. Among 500 patient 72
% male and 28 % female with mostaffected age group was 20 to 45 years of age. Most predominant cause of eye
loss was a traumatic event (62.2 %), where sports injury among male and kitchen injury in female was frequent
reported. Other causes were road traffic accidents, and tumors. Most patients came from rural areas belong to low
socio-economic condition, which may act as an associated factor in eye loss. However, in 98 % cases, patients were
satisfied after receiving prosthesis.

Conclusion: The increasing application of ocular prosthesis in students and housewife for sports injury and kitchen
accident respectively suggests that preventive measures for these events have not been addressed accordingly, and
might represent a neglected public-health issue.

Key Words: ocular prosthesis; eye defects; sports injury ; kitchen accident

INTRODUCTION

Eyes are considered as the first featuring limb of the socket. Initially this prosthesis was used to compose of stones
maxillo-facial region .1 It is an incredible organ that is respon- to copper, bronze, and gold.7, 8 However, OP made of
sible for making the sense of environment. But various medical-grade acrylics or silicone elastomers became more
pathologic conditions such as intraocular malignancy (uveal popular in the twentieth century for its aesthetic and biocom-
melanoma and retinoblastoma), infections, congenital patible properties . 9
defects and trauma cause painful eye or decrease visual
potential and discolored eye.2,3 In such cases an enucleation, Recently, OP has become a popular treatment of choice
evisceration, orbital exenteration of eye is a common among the doctors in Bangladesh. Despite their widespread
treatment of choice in many countries 4. This unfortunate loss distribution among Bangladeshi populations, a scientific
or absence of an eye not only makes daily life difficult but register of patients with ocular prosthesis is currently lacking.
can act as a trigger to significant physical and emotional To the best of our knowledge, no scientific study has been
problems as well as social abuse.5 conducted to identify the cause that led to the need of an OP,
and distribution of this device among different age or gender
Ocular prosthesis (OP) is a branch of maxillo-facial prosth- group among the Bangladeshi population.
odontics, a common treatment plan for lost-eye cases that
restore the eye with an aim to give natural appearance of the Therefore, in this study we aim to analyze the epidemiologic
eye and improve quality of life. 6 The first introduction of OP data of patients receivedOP from healthcare center at Dhaka
was made 4800 years ago to supply in in the shrunken eye in last 15 years to evaluate its distribution in different age and
6
1. Professor Dr. Mohammad Saiful Islam, Professor (c.c) & Head, Department of Prosthodontics, University Dental College & Hospital, 120/A Outer
Circular Rd, Dhaka 1217, Bangladesh 2. Dr. Mohammad Ibtehaz Alam, Prostho Dental Implant Center, House 43, Dhanmondi 27, Dhaka 1209,
Bangladesh, Department of Periodontology and Oral Pathology, University Dental College & Hospital, 120/A Outer Circular Rd, Dhaka 1217,
Bangladesh; 3. Dr. Md. Ismail Hossain , Assistant Prof,oculuplasty Department,National Institute of Opthalmology and Hospital, Dhaka,Bangladesh
4. Dr. Sharafat Hossain Associate Professor , Department of Prosthodontics, University Dental College & Hospital, 120/A Outer Circular Rd, Dhaka
1217, Bangladesh, 5. Dr. Nazmuz Sakib Mohammad, Lecturer Department of Prosthodontics, University Dental College & Hospital, 120/A Outer
Circular Rd, Dhaka 1217, Bangladesh. 6. Dr. Mehdi Al Masud, Lecturer Department of Prosthodontics, University Dental College & Hospital, 120/A
Outer Circular Rd, Dhaka 1217, Bangladesh. , 7. Dr. Nusrat Tamij, Lecturer Department of Prosthodontics, University Dental College & Hospital,
120/A Outer Circular Rd, Dhaka 1217, Bangladesh.
 Prevalence and consequence of customized ocular prosthesis in last 15 years at Dhaka city, Bangladesh: A retrospective study

gender group, cause of eye loss, and factors associated in eye loss.
Also, in this study we observed the quality of life and their
satisfaction level, after receiving the prosthesis among the patients.
MATERIALS AND METHODS
This study was conducted in accordance with the tenets of the
"Declaration of Helsinki" and obtained written consent from the
patients to use their medical records. We analyzed the data of
500 patients who are already registered in our archive and
received OP from 2007-2022. Inclusion criteria were
determined by the presence of the following data, such as
patient's gender, age, cause of eye loss, occupation, socio-
economic condition, area of residence and quality of life after
treatment in everyone’s record. Exclusion criteria were the
incomplete compilation of medical records, and the lack of clear
and reliable clinical data.
Once we grouped data from all patients according to gender
and age, then analyzed the different etiology of eye loss classi-
fied as congenital, tumor /carcinoma, accident/ trauma in male
and female. Further, accidents/ trauma was sub-grouped into
road traffic accidents (RTA), sports injury or kitchen injury for
clear understanding of eye loss. We also sub divide the patients
considering the following age groups as 0-5 years, 6-19 years,
Next, we analyze the prevalence of the gender and the differ-
ent age groups in receiving OP. Our sample size consisted of
361 males (72 %) and 139 females (28 %), with an average of
33.32 years indicating that incidence of eye loss in male 3
times higher in number than females (Figure 2A, 2B). Then,
we analyze the age group, that has most tendency to eye loss.
The distribution of our patients in different age groups was as
follows: 26 patients from 0 to 5 years, 47 patients from 6 to
19 years, 308 patients from 20 to 44 years, 104 patients from
45 to 60 years, 15 patients from 60+ years of age or older
(Figure 3A). When the results are converted into percentage
in pie chart, it is showing that both male and female of age
group from 20 – to 44 years are mostly affected than any
other age group (M: 63 %, F: 58 %). Age group from 45 – to
60 years (M: 19 %, F: 27 %), had the second most
cases.However, age group of 0-5 years, 6-19 years, and 60+
years showed less than 10 % incident (Figure 3B, 3C). This
data suggesting that number of cases of OP in male higher
than compared to female. Also, prevalence of OP is most
found in middle aged (20 – 44 years) and old aged (45-60)
people but few in young age.
A
400 361

Number of Cases
20-44 years, 45-60years, 60 years thereafter to identify the risk 300
age. Moreover, we studied the socio-economic conditions and
200
0.0
0.2
0.4
0.6

area of residence to understand their relation in eye loss.

0.8
1.0

130
Finally, we assess the quality of life after receiving OP.
100
Percentage of OP application in all results was expressed as a
proportion of the total number of patients as reported. 0
Female Male3
RESULTS Different gender group

A total of 500 patients having OP were included in this study

in time span from 2007 to 2022. To understand the preva-
lence of OP over the years we analyzed the number of B Female Male
supplied prostheses in the time span of 2007-2011, 20012-
2016 2017-2022. Interestingly we found that overall cases of
OP increased over the time with 20 % in 2007-2011, 30 % in
2012-2016, 50% in 2017-2022 (Figure 1). This data indicat-
ing that incidence of eye loss and prevalence of OP increas-
ing gradually in Bangladeshi population.
250

200
Number of Cases

28%
150

100 72%
50

0
2007-2011 2012-2016 2017-2022 Figure 2: The distribution of ocular defects in different
Time ( Years) gender groups expressed in total numbers (A) and in percent-
Figure 1:The prevalence of ocular prosthesis in last 15 years ages (B).
in Bangladesh.
07
Bangladesh Dental College Journal, January’2023; Vol-14, No.1
 Islam MS, Alam MI, Hossain MI, Hossain S, Mohammad NS, Masud MA, Tamij N

350
A Male 250
300 Female
250 81 220
Number of Cases

200
200
150 Male
100 227 A
37
50 11
7 67 3
0 19 36 1 150
0-5 6-19 20-44 45-60 60+
Age group years
104

B 100
3% 5%
10% 60+
19% 45-60
20-44 50
37
6-19
63% 0-5

0
Congental Tumour/ Accident/
Male Carcinoma Trauma

C 2%
5%
8% 60+ Male
27% 45-60
100
20-44 91
6-19
0-5
58%
80
Female B
60
Figure 3: The distribution of ocular prosthetic cases in differ-
ent age groups expressed in total numbers (A), and in
percentages for male (B) or female (C). 40 36

Further, to identify the increasing application of OP, we

investigate the cause of eye loss. Accident/ traumatic injury
20 12
was by far the most common cause of eye loss in both in male
(60.94 %) and in female (65.46 %), accounting for more than
half of all cases of our study population (n=311; 62.2 %).
Other causes included 28 % cases are due to tumor or cancer, 0
and 9.8 % are congenital in total population (Figure 4A, 4C).
Congenital Tumour/ Accident/
Due to the high percentage of traumatic or accidental eye Carcinoma Trauma
loss, we are then performing a subgroup analysis to elucidate
the type of traumatic injury. Interestingly, we found that
Female
sports injury is the most predominant cause of eye loss in
male (60 %), but surprisingly, hot oil or spice spark (58 %) in
kitchen was the common cause in female for ocular damage.
RTA is the second most common cause of eye loss, which
showed similar tendency in male (28 %) and female (29 %)
population (Figure 4B, 4D).
08
Bangladesh Dental College Journal, January’2023; Vol-14, No.1
 Prevalence and consequence of customized ocular prosthesis in last 15 years at Dhaka city, Bangladesh: A retrospective study

Our previous data suggested that male is 3x more susceptible

to eye loss than compared to female and, as accident and
Male trauma was the common underlying cause, therefore, we then
12%
decided to analyze workplace to identify the relation of
occupation with the number of cases. In this regard after
analyzing data, we confirm that highest affected population
are from student (45 %), then housewife (20 %),
businessman(16%), service holder (10 %), others (9 %)
(Figure 5A, 5B). This data is consistent with our previous
result, while most male lost their eye by sports injury among
the students, but female working as housewives are mostly
C 60% lost their eye due to cooking injury in kitchen. Taken together
28% our analysis indicatesthat, eye loss may strongly associate
with workstation or professional act.

Considering underlying etiology and occupational history we

thought there may also be several factors such as socio-
economic conditions or area of residence may involve. While
we were analyzing, this is an interesting finding that, we
found out most of the patients of our study population came
Sports Injury RTA Others with low socio-economic condition (98 %) but very few from
high economic condition (2%) . A consistent data we have
13% also found where patient of 98 % from rural area but only 2%
from urban. Our data suggests that, economic conditions,
lack of education or situation negligence could be associated
auxiliary factors responsible for slow ocular damage.

Female 58% DISCUSSION

29%
In this study, for the first time in Bangladesh we analyze the
D largest population of patients with OP in scientific literature.
Our primary aim was to report data on prevalence of OP in
different age and gender groups, and cause of eye loss.
Although, application of OP was not familiar in early time of
Others
twenty first century in Bangladesh, but, interestingly we
Sports Injury RTA
observed an increasing number of OP applied in patients with
Figure 4: Etiology of eye loss in Bangladeshi population(A). ocular malformations over the years, which may reflect
Types of specific accident or trauma responsible for eye loss indirect evidence that disease or accident followed an upward
in male (B) or in female (C). trend. It is very consistent with the data previously reported
250 in other countries . Similar to other part of world, in
201 Bangladesh family10,11
awareness has developed to norm physi-
cal and emotional stress gone through in patient, and for
200 aesthetic appearance acceptance of OP has gradually rising.
12
150 Although, no difference was observed of OP in gender
distribution, as already reported in scientific literature.
0.0
0.2
0.4
0.6
0.8
1.0

101 But, it shows a difference of OP application in population

100 81
of Bangladesh, where 72 % patients were found male, but13
51 28% was female which was far less in comparison to men.
46
50 We found males in work age from 20 to 60 years, represent
the category at higher risk of an event leading to OP appli-
cation. Critically due to traumatic injuries such as domestic
0
Student House wife Bussinessman Service Holder Others accidents, road accidents, infectious and cancerous disease
of eye or other kind of accidents including fireworks and
Figure 5: The distribution of ocular defects in different congenital defect. It may reflect that, higher number of
occupational groups expressed in total numbers

09
Bangladesh Dental College Journal, January’2023; Vol-14, No.1
 Islam MS, Alam MI, Hossain MI, Hossain S, Mohammad NS, Masud MA, Tamij N
work-related injuries in men due to their typical occupation
type. But, surprisingly, 57.61% of men was student in
occupation and the rest was businessman (19.1 %), service
holder (13.29 %), others (9.97 %). It is interesting to under-
line that sports injury from sharp instruments like pen and
pencil was the common and predominant common cause of
eye injury initially among students. Gradual vision loss was
the consequence in students resulting from this type of injury,
while left untreated and neglected. On the other hand, the rate
of congenital and carcinogenic eye loss was less.
In contrast, female mostly working as housewife under in age
group from 20 to 60 years lost their eyes than any other
occupation such as businessman, service holders, students,
and others. Our study uncovers one strange but alarming
finding that is most likely different from other part of the
world considering female occupation.14 The analysis of the
incidence revealed that flash of hot oil or spice during
cooking was the reason of eye injury and gradual vision loss
was the prime reason for OP application in female. It is
probably reflecting the negligence in early diagnosis and
treatment, that increases the vision loss rates of this unfortu-
nate event.
491
500
400
300
A tance of creating a register of ocular prosthesis wearers to
200
100
9
0 CONCLUSION:
Satisfied Not Satisfied
2%
Not Satisfied
B Satisfied
0.0
0.2
0.4
0.6
0.8
1.0
98%
Figure 6: The satisfaction level of patients who received
ocular prosthesis expressed in total numbers (A) or in
percentages (B)
In spite of the huge policy-maker efforts in increasing safety
on the RTA with several measures eye injuries did not
10
decrease over time in foreign country but in Bangladesh such
cases are under 30 % due to effective and appropriate
measure such as counseling and television advertise
presented by government.11,15 Nevertheless, traumatic
injuries still represent the first cause of ocular prosthesis need,
with 63% of all patients in our study population and a higher
prevalence in males, which may be explained by a higher
number of accidents of various kinds, more active games, and
more dangerous sports in male students.16,17,18
Our secondary aim was to identify the associated factors that
may influence increasing ocular prosthesis application. Also,
we assessed satisfaction level of patients after OP applica-
tion. The patients of our study were predominantly from low
socio-economic conditions. These findings were similar to
those of other international reports.19,20 Also, most of the
participants were from nearby cities or urban areas. In those
patient’s vision was normal initially after injuries but gradual
loss of vision occurs while left untreated and no measures/
therapy were taken. This data clearly demonstrates that, a
lack of human resources in the discipline of ocular prosthet-
ics and a lack of finances for treatment in those remote areas
may act as auxiliary cause of eye loss. Almost 98 % patients
of our study satisfied with the treatment, however 2 % was
not, among them, all are from 60+ age group. It is due to lack
of retention and irritation of OP in ocular cavity. It is probably
because of the shrinkage of ocular cavity due to long term
absence or no application of OP after eye loss.14,21
This study highlights the importance of education in prevent-
ing accidents and the early diagnosis and treatment of ocular
injury. This literature emphasizes the need for and impor-
provide healthcare and policy makers to address preventive
measures. In this regard, to make concreate policy such kind
of study needs to be done nationwide.
The results of this study clearly demonstrate that ocular
prostheses gradually increasing in Bangladeshprecisely in
rural residence, with predominant tendency in middle aged
male compared to female. Sports injury and kitchen injury
during cooking was the main cause of eye loss suggests
through counseling, campaigningneeds to be addressed to
educate and make aware what needs to be done immediately
ocular injury event. This may prove beneficial for long-term
prevention strategies aimed at reducing OP.
.
Conflict of interest: The authors declare no conflict of
interest.
Disclaimer:This paper has not been published nor submitted
in full or in part elsewhere.
Bangladesh Dental College Journal, January’2023; Vol-14, No.1
 Prevalence and consequence of customized ocular prosthesis in last 15 years at Dhaka city, Bangladesh: A retrospective study
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