PURPOSE:: To describe the use of Prosthetic Replacement of the Ocular Surface Ecosystem (PROSE) device in the management of complex oculoplastic pathology. METHODS:: The authors retrospectively reviewed the records of individuals over 18 years of age who were referred and successfully fit with the PROSE scleral device between January 1995 and June 2015. RESULTS:: Nine cases were identified that had complex oculoplastic disease and severe corneal surface disease. All patients with ptosis had improvement in marginal reflex distance-1 following PROSE and 5 of 7 patients with ptosis were spared further surgical intervention. Two underwent surgical repair with successful corneal stabilization with PROSE. Those with eyelid malposition including ectropion, entropion, or trichiasis experienced improvement in their corneal surface and deferred further surgical intervention. CONCLUSIONS:: These cases highlight the use of the PROSE device to elevate the upper eyelid in patients with lagophthalmos and ptosis, stabilize the corneal surface to allow for additional eyelid surgery to be performed safely, and protect the corneal surface in patients with intractable trichiasis and entropion. Prosthetic Replacement of the Ocular Surface Ecosystem should be considered in patients with complex oculoplastic pathology to improve visual function, corneal surface disease, and eyelid position.
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